23D2042387 CLIA NUMBER - WALGREENS #12688

Laboratory Demographics

  • CLIA Code: 23D2042387
  • Facility Name: WALGREENS #12688
  • Facility Address: 848 S KALAMAZOO STREET
    PAW PAW, MI
    ZIP 49079
  • Facility Phone: 269 657-4984
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COLLIN T. PROKSCH
  • NPI Number: 1720225618
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2042387
LAB Type Pharmacy
Facility Name WALGREENS #12688
Street 848 S KALAMAZOO STREET
City PAW PAW
State MI
ZIP 49079
Phone 269 657-4984
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director COLLIN T. PROKSCH

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