23D2058763 CLIA NUMBER - WALGREENS #05291

Laboratory Demographics

  • CLIA Code: 23D2058763
  • Facility Name: WALGREENS #05291
  • Facility Address: 13664 23 MILE ROAD
    UTICA, MI
    ZIP 48315
  • Facility Phone: 586 247-1199
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEXA T. JOH
  • NPI Number: 1639184765
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2058763
LAB Type Pharmacy
Facility Name WALGREENS #05291
Street 13664 23 MILE ROAD
City UTICA
State MI
ZIP 48315
Phone 586 247-1199
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type Pharmacy
Lab Director ALEXA T. JOH

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