14D2291247 CLIA NUMBER - WALGREENS 05428

Laboratory Demographics

  • CLIA Code: 14D2291247
  • Facility Name: WALGREENS 05428
  • Facility Address: 632 ROGER WILLIAMS AVE
    HIGHLAND PARK, IL
    ZIP 60035
  • Facility Phone: 847 432-8170
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SALAM H. AWADALLAH
  • NPI Number: 1598772675
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2291247
LAB Type Pharmacy
Facility Name WALGREENS 05428
Street 632 ROGER WILLIAMS AVE
City HIGHLAND PARK
State IL
ZIP 60035
Phone 847 432-8170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/6/2025
Certificate Expiration Date 10/5/2027
Facility Type Pharmacy
Lab Director SALAM H. AWADALLAH

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