23D2042864 CLIA NUMBER - WALGREENS #12777

Laboratory Demographics

  • CLIA Code: 23D2042864
  • Facility Name: WALGREENS #12777
  • Facility Address: 4365 LAKE MICHIGAN DRIVE N W
    WALKER, MI
    ZIP 49534
  • Facility Phone: 616 791-1655
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PATRICK T. FEWLESS
  • NPI Number: 1891700902
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2042864
LAB Type Pharmacy
Facility Name WALGREENS #12777
Street 4365 LAKE MICHIGAN DRIVE N W
City WALKER
State MI
ZIP 49534
Phone 616 791-1655
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/1/2025
Certificate Expiration Date 3/31/2027
Facility Type Pharmacy
Lab Director PATRICK T. FEWLESS

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