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14D2283943 CLIA NUMBER - CVS/PHARMACY #06448 HIGHLAND PARK CVS LLC

Laboratory Demographics

CLIA Number: 14D2283943

Facility Name: CVS/PHARMACY #06448 HIGHLAND PARK CVS LLC

Facility Address:
1101 PEORIA ST
WASHINGTON, IL
ZIP 61571
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Facility Phone Number: 309 444-2301

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1366545139

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 14D2283943
LAB Type Pharmacy
Facility Name CVS/PHARMACY #06448 HIGHLAND PARK CVS LLC
Street 1101 PEORIA ST
City WASHINGTON
State IL
ZIP 61571
Phone 309 444-2301
CertificateType 4
CertificateEffectiveDate 6/14/2023
CertificateExpirationDate 6/13/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024