23D2043091 CLIA NUMBER - WALGREENS #12508

Laboratory Demographics

  • CLIA Code: 23D2043091
  • Facility Name: WALGREENS #12508
  • Facility Address: 1500 BRIDGE STREET
    CHARLEVOIX, MI
    ZIP 49720
  • Facility Phone: 231 547-1356
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREG FEDIRKO
  • NPI Number: 1396992814
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2043091
LAB Type Pharmacy
Facility Name WALGREENS #12508
Street 1500 BRIDGE STREET
City CHARLEVOIX
State MI
ZIP 49720
Phone 231 547-1356
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 GREG FEDIRKO

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This page was last updated on: 6/4/2025