23D2042400 CLIA NUMBER - WALGREENS #11415

Laboratory Demographics

  • CLIA Code: 23D2042400
  • Facility Name: WALGREENS #11415
  • Facility Address: 6840 LAKE MICHIGAN DRIVE
    ALLENDALE, MI
    ZIP 49401
  • Facility Phone: 616 895-2200
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFREY A. NIEBOER
  • NPI Number: 1447446711
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2042400
LAB Type Pharmacy
Facility Name WALGREENS #11415
Street 6840 LAKE MICHIGAN DRIVE
City ALLENDALE
State MI
ZIP 49401
Phone 616 895-2200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/28/2025
Certificate Expiration Date 8/27/2027
Facility Type Pharmacy
Lab Director JEFFREY A. NIEBOER

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