23D2040395 CLIA NUMBER - WALGREENS #12893

Laboratory Demographics

  • CLIA Code: 23D2040395
  • Facility Name: WALGREENS #12893
  • Facility Address: 11980 FULTON STREET E
    LOWELL, MI
    ZIP 49331
  • Facility Phone: 616 897-3160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WALTER JALOWIECZ
  • NPI Number: 1447480835
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2040395
LAB Type Pharmacy
Facility Name WALGREENS #12893
Street 11980 FULTON STREET E
City LOWELL
State MI
ZIP 49331
Phone 616 897-3160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director WALTER JALOWIECZ

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