23D2011293 CLIA NUMBER - WALGREENS #04585

Laboratory Demographics

  • CLIA Code: 23D2011293
  • Facility Name: WALGREENS #04585
  • Facility Address: 17071 FORT ST
    RIVERVIEW, MI
    ZIP 48193
  • Facility Phone: 734 281-2927
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMIE J. BARTOLONI
  • NPI Number: 1417238452
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2011293
LAB Type Pharmacy
Facility Name WALGREENS #04585
Street 17071 FORT ST
City RIVERVIEW
State MI
ZIP 48193
Phone 734 281-2927
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Pharmacy
Lab Director JAMIE J. BARTOLONI

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