23D2061289 CLIA NUMBER - WALGREENS #04797

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Laboratory Demographics

CLIA Number: 23D2061289

Facility Name: WALGREENS #04797

Facility Address:
6331 E JEFFERSON AVENUE
DETROIT, MI
ZIP 48207
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Facility Phone Number: 313 567-4239

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1205841343

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	23D2061289
LAB Type	Pharmacy
Facility Name	WALGREENS #04797
Street	6331 E JEFFERSON AVENUE
City	DETROIT
State	MI
ZIP	48207
Phone	313 567-4239
CertificateType	4
CertificateEffectiveDate	10/21/2023
CertificateExpirationDate	10/20/2025
FacilityType	Waiver

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