23D2058753 CLIA NUMBER - WALGREENS #05322

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Laboratory Demographics

CLIA Number: 23D2058753

Facility Name: WALGREENS #05322

Facility Address:
11635 E 13 MILE ROAD
WARREN, MI
ZIP 48093
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Facility Phone Number: 586 446-0853

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477568509

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	23D2058753
LAB Type	Pharmacy
Facility Name	WALGREENS #05322
Street	11635 E 13 MILE ROAD
City	WARREN
State	MI
ZIP	48093
Phone	586 446-0853
CertificateType	4
CertificateEffectiveDate	6/17/2023
CertificateExpirationDate	6/16/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024