23D2036065 CLIA NUMBER - WALGREENS #11953

Laboratory Demographics

  • CLIA Code: 23D2036065
  • Facility Name: WALGREENS #11953
  • Facility Address: 300 EAST F ST
    IRON MOUNTAIN, MI
    ZIP 49801
  • Facility Phone: 906 774-0563
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAY E. LASSILA
  • NPI Number: 1043486913
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2036065
LAB Type Pharmacy
Facility Name WALGREENS #11953
Street 300 EAST F ST
City IRON MOUNTAIN
State MI
ZIP 49801
Phone 906 774-0563
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/5/2025
Certificate Expiration Date 10/4/2027
Facility Type Pharmacy
Lab Director JAY E. LASSILA

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