23D2061250 CLIA NUMBER - WALGREENS #04298

Laboratory Demographics

  • CLIA Code: 23D2061250
  • Facility Name: WALGREENS #04298
  • Facility Address: 29200 6 MILE ROAD
    LIVONIA, MI
    ZIP 48152
  • Facility Phone: 734 427-3237
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IBRAHIM M. BASMA
  • NPI Number: 1194730218
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2061250
LAB Type Pharmacy
Facility Name WALGREENS #04298
Street 29200 6 MILE ROAD
City LIVONIA
State MI
ZIP 48152
Phone 734 427-3237
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Pharmacy
Lab Director IBRAHIM M. BASMA

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