14D2295171 CLIA NUMBER - WALGREENS 07179

Laboratory Demographics

  • CLIA Code: 14D2295171
  • Facility Name: WALGREENS 07179
  • Facility Address: 2 E ROOSEVELT RD
    CHICAGO, IL
    ZIP 60605
  • Facility Phone: 312 212-1583
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CAN X. LAO
  • NPI Number: 1548275753
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2295171
LAB Type Pharmacy
Facility Name WALGREENS 07179
Street 2 E ROOSEVELT RD
City CHICAGO
State IL
ZIP 60605
Phone 312 212-1583
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/6/2023
Certificate Expiration Date 12/5/2025
Facility Type Pharmacy
Lab Director CAN X. LAO

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