23D2036119 CLIA NUMBER - WALGREENS #10405

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Laboratory Demographics

CLIA Number: 23D2036119

Facility Name: WALGREENS #10405

Facility Address:
2101 ASHMUN STREET
SAULT SAINTE MARIE, MI
ZIP 49783
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Facility Phone Number: 906 632-5135

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1811051188

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	23D2036119
LAB Type	Pharmacy
Facility Name	WALGREENS #10405
Street	2101 ASHMUN STREET
City	SAULT SAINTE MARIE
State	MI
ZIP	49783
Phone	906 632-5135
CertificateType	4
CertificateEffectiveDate	5/4/2023
CertificateExpirationDate	5/3/2025
FacilityType	Waiver

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