23D2040397 CLIA NUMBER - WALGREENS #09691

Laboratory Demographics

  • CLIA Code: 23D2040397
  • Facility Name: WALGREENS #09691
  • Facility Address: 1100 PHOENIX STREET
    SOUTH HAVEN, MI
    ZIP 49090
  • Facility Phone: 269 637-1457
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN S. PULLEN
  • NPI Number: 1245245554
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2040397
LAB Type Pharmacy
Facility Name WALGREENS #09691
Street 1100 PHOENIX STREET
City SOUTH HAVEN
State MI
ZIP 49090
Phone 269 637-1457
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 BRIAN S. PULLEN

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This page was last updated on: 6/4/2025