23D2058768 CLIA NUMBER - WALGREENS #04661

Laboratory Demographics

  • CLIA Code: 23D2058768
  • Facility Name: WALGREENS #04661
  • Facility Address: 4019 METROPOLITAN PARKWAY
    STERLING HEIGHTS, MI
    ZIP 48310
  • Facility Phone: 586 446-8104
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUDHA KUDAPA
  • NPI Number: 1912912049
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2058768
LAB Type Pharmacy
Facility Name WALGREENS #04661
Street 4019 METROPOLITAN PARKWAY
City STERLING HEIGHTS
State MI
ZIP 48310
Phone 586 446-8104
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/2/2025
Certificate Expiration Date 3/1/2027
Facility Type Pharmacy
Lab Director SUDHA KUDAPA

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This page was last updated on: 3/20/2025