23D2041142 CLIA NUMBER - WALGREENS #12288

Laboratory Demographics

  • CLIA Code: 23D2041142
  • Facility Name: WALGREENS #12288
  • Facility Address: 100 CABELAS BLVD E
    DUNDEE, MI
    ZIP 48131
  • Facility Phone: 734 529-5395
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIM STIFF
  • NPI Number: 1912156175
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2041142
LAB Type Pharmacy
Facility Name WALGREENS #12288
Street 100 CABELAS BLVD E
City DUNDEE
State MI
ZIP 48131
Phone 734 529-5395
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Pharmacy
Lab Director TIM STIFF

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