23D2042391 CLIA NUMBER - WALGREENS #05095

Laboratory Demographics

  • CLIA Code: 23D2042391
  • Facility Name: WALGREENS #05095
  • Facility Address: 1964 FULLER AVENUE N E
    GRAND RAPIDS, MI
    ZIP 49505
  • Facility Phone: 616 364-7071
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STEPHANIE WILCOTT
  • NPI Number: 1992710016
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 23D2042391
LAB Type Pharmacy
Facility Name WALGREENS #05095
Street 1964 FULLER AVENUE N E
City GRAND RAPIDS
State MI
ZIP 49505
Phone 616 364-7071
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2025
Certificate Expiration Date 9/20/2027
Facility Type Pharmacy
Lab Director STEPHANIE WILCOTT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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