23D2042383 CLIA NUMBER - WALGREENS #05117

Laboratory Demographics

  • CLIA Code: 23D2042383
  • Facility Name: WALGREENS #05117
  • Facility Address: 378 BALDWIN STREET
    JENISON, MI
    ZIP 49428
  • Facility Phone: 616 667-8695
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOEL R. BOUWMAN
  • NPI Number: 1275548398
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2042383
LAB Type Pharmacy
Facility Name WALGREENS #05117
Street 378 BALDWIN STREET
City JENISON
State MI
ZIP 49428
Phone 616 667-8695
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Pharmacy
Lab Director JOEL R. BOUWMAN

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