23D2011290 CLIA NUMBER - WALGREENS #04749

Laboratory Demographics

  • CLIA Code: 23D2011290
  • Facility Name: WALGREENS #04749
  • Facility Address: 1765 FORT ST
    LINCOLN PARK, MI
    ZIP 48146
  • Facility Phone: 313 928-8638
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HASSAN M. SHEHADI
  • NPI Number: 1265447387
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2011290
LAB Type Pharmacy
Facility Name WALGREENS #04749
Street 1765 FORT ST
City LINCOLN PARK
State MI
ZIP 48146
Phone 313 928-8638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director HASSAN M. SHEHADI

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