23D2059522 CLIA NUMBER - WALGREENS #11955

Laboratory Demographics

  • CLIA Code: 23D2059522
  • Facility Name: WALGREENS #11955
  • Facility Address: 1001 E M 21
    OWOSSO, MI
    ZIP 48867
  • Facility Phone: 989 725-6309
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACEY J. JORDAN
  • NPI Number: 1215183595
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2059522
LAB Type Pharmacy
Facility Name WALGREENS #11955
Street 1001 E M 21
City OWOSSO
State MI
ZIP 48867
Phone 989 725-6309
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Pharmacy
Lab Director TRACEY J. JORDAN

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