14D2289643 CLIA NUMBER - WALGREENS 12150

Laboratory Demographics

  • CLIA Code: 14D2289643
  • Facility Name: WALGREENS 12150
  • Facility Address: 5158 N LINCOLN AVE
    CHICAGO, IL
    ZIP 60625
  • Facility Phone: 773 907-8490
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JULIE H. VO
  • NPI Number: 1114104908
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2289643
LAB Type Pharmacy
Facility Name WALGREENS 12150
Street 5158 N LINCOLN AVE
City CHICAGO
State IL
ZIP 60625
Phone 773 907-8490
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/13/2025
Certificate Expiration Date 9/12/2027
Facility Type Pharmacy
Lab Director JULIE H. VO

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