14D2287960 CLIA NUMBER - WALGREENS 01096

Laboratory Demographics

  • CLIA Code: 14D2287960
  • Facility Name: WALGREENS 01096
  • Facility Address: 3646 N BROADWAY ST
    CHICAGO, IL
    ZIP 60613
  • Facility Phone: 773 549-3808
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SOO HYUN J ON
  • NPI Number: 1275548596
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2287960
LAB Type Pharmacy
Facility Name WALGREENS 01096
Street 3646 N BROADWAY ST
City CHICAGO
State IL
ZIP 60613
Phone 773 549-3808
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/18/2025
Certificate Expiration Date 8/17/2027
Facility Type Pharmacy
Lab Director SOO HYUN J ON

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