23D2061405 CLIA NUMBER - WALGREENS #04454

Laboratory Demographics

  • CLIA Code: 23D2061405
  • Facility Name: WALGREENS #04454
  • Facility Address: 24100 NOVI ROAD
    NOVI, MI
    ZIP 48375
  • Facility Phone: 248 349-6771
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAKSHMI TAMMAREDDY
  • NPI Number: 1720093842
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2061405
LAB Type Pharmacy
Facility Name WALGREENS #04454
Street 24100 NOVI ROAD
City NOVI
State MI
ZIP 48375
Phone 248 349-6771
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/14/2025
Certificate Expiration Date 6/13/2027
Facility Type Pharmacy
Lab Director LAKSHMI TAMMAREDDY

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