23D2059916 CLIA NUMBER - WALGREENS #10489

Laboratory Demographics

  • CLIA Code: 23D2059916
  • Facility Name: WALGREENS #10489
  • Facility Address: 729 W HOUGHTON LAKE DRIVE
    PRUDENVILLE, MI
    ZIP 48651
  • Facility Phone: 989 366-5324
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SYED A. ALI
  • NPI Number: 1811196694
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2059916
LAB Type Pharmacy
Facility Name WALGREENS #10489
Street 729 W HOUGHTON LAKE DRIVE
City PRUDENVILLE
State MI
ZIP 48651
Phone 989 366-5324
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/21/2025
Certificate Expiration Date 4/20/2027
Facility Type Pharmacy
Lab Director SYED A. ALI

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