23D2059920 CLIA NUMBER - WALGREENS #04501

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Laboratory Demographics

CLIA Number: 23D2059920

Facility Name: WALGREENS #04501

Facility Address:
22380 MOROSS ROAD
DETROIT, MI
ZIP 48236
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Facility Phone Number: 313 642-1129

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1730194853

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	23D2059920
LAB Type	Pharmacy
Facility Name	WALGREENS #04501
Street	22380 MOROSS ROAD
City	DETROIT
State	MI
ZIP	48236
Phone	313 642-1129
CertificateType	4
CertificateEffectiveDate	7/30/2023
CertificateExpirationDate	7/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024