23D2058878 CLIA NUMBER - WALGREENS #11395

Laboratory Demographics

  • CLIA Code: 23D2058878
  • Facility Name: WALGREENS #11395
  • Facility Address: 56805 VAN DYKE AVENUE
    UTICA, MI
    ZIP 48316
  • Facility Phone: 586 786-1856
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHERINE KALLASIDES
  • NPI Number: 1952560088
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2058878
LAB Type Pharmacy
Facility Name WALGREENS #11395
Street 56805 VAN DYKE AVENUE
City UTICA
State MI
ZIP 48316
Phone 586 786-1856
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Pharmacy
Lab Director KATHERINE KALLASIDES

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