23D2059226 CLIA NUMBER - WALGREENS #11689

Laboratory Demographics

  • CLIA Code: 23D2059226
  • Facility Name: WALGREENS #11689
  • Facility Address: 2045 S I 75 BUSINESS LOOP
    GRAYLING, MI
    ZIP 49738
  • Facility Phone: 989 344-0374
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY D. PETERSEN
  • NPI Number: 1720248859
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2059226
LAB Type Pharmacy
Facility Name WALGREENS #11689
Street 2045 S I 75 BUSINESS LOOP
City GRAYLING
State MI
ZIP 49738
Phone 989 344-0374
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director TIMOTHY D. PETERSEN

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