23D2058759 CLIA NUMBER - WALGREENS #05675

Laboratory Demographics

  • CLIA Code: 23D2058759
  • Facility Name: WALGREENS #05675
  • Facility Address: 450 N PARK BLVD
    LAKE ORION, MI
    ZIP 48362
  • Facility Phone: 248 814-7315
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN C. STEPANIUK
  • NPI Number: 1548275670
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2058759
LAB Type Pharmacy
Facility Name WALGREENS #05675
Street 450 N PARK BLVD
City LAKE ORION
State MI
ZIP 48362
Phone 248 814-7315
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Pharmacy
Lab Director JOHN C. STEPANIUK

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