14D2283719 CLIA NUMBER - CVS/PHARMACY 06923 HIGHLAND PARK CVS LLC

Laboratory Demographics

  • CLIA Code: 14D2283719
  • Facility Name: CVS/PHARMACY 06923 HIGHLAND PARK CVS LLC
  • Facility Address: 208 W JACKSON ST
    SULLIVAN, IL
    ZIP 61951
  • Facility Phone: 217 728-7216
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ANDREW ALTMAN
  • NPI Number: 1023111796
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2283719
LAB Type Physician Office
Facility Name CVS/PHARMACY 06923 HIGHLAND PARK CVS LLC
Street 208 W JACKSON ST
City SULLIVAN
State IL
ZIP 61951
Phone 217 728-7216
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2025
Certificate Expiration Date 6/11/2027
Facility Type Physician Office
Lab Director ANDREW ALTMAN

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This page was last updated on: 9/29/2025