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23D1089746 CLIA NUMBER - WALGREENS #11264

Laboratory Demographics

CLIA Number: 23D1089746

Facility Name: WALGREENS #11264

Facility Address:
21790 21 MILE ROAD
MACOMB, MI
ZIP 48044
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Facility Phone Number: 586 469-0254

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1720263122

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 23D1089746
LAB Type Pharmacy
Facility Name WALGREENS #11264
Street 21790 21 MILE ROAD
City MACOMB
State MI
ZIP 48044
Phone 586 469-0254
CertificateType 4
CertificateEffectiveDate 6/17/2023
CertificateExpirationDate 6/16/2025
FacilityType Waiver

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