23D2012841 CLIA NUMBER - WALGREENS #10080

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Laboratory Demographics

CLIA Number: 23D2012841

Facility Name: WALGREENS #10080

Facility Address:
7920 SHAVER RD
PORTAGE, MI
ZIP 49024
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Facility Phone Number: 269 324-9988

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1083629190

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	23D2012841
LAB Type	Pharmacy
Facility Name	WALGREENS #10080
Street	7920 SHAVER RD
City	PORTAGE
State	MI
ZIP	49024
Phone	269 324-9988
CertificateType	4
CertificateEffectiveDate	10/12/2023
CertificateExpirationDate	10/11/2025
FacilityType	Waiver

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