23D2067081 CLIA NUMBER - KEYSTONE PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2067081
  • Facility Name: KEYSTONE PHARMACY
  • Facility Address: 4021 CASCADE RD SE, SUITE 50
    GRAND RAPIDS, MI
    ZIP 49546
  • Facility Phone: 616 974-9792
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DAVID J. MILLER
  • NPI Number: 1316049745
  • Taxonomy: 3336C0004X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2067081
LAB Type Pharmacy
Facility Name KEYSTONE PHARMACY
Street 4021 CASCADE RD SE, SUITE 50
City GRAND RAPIDS
State MI
ZIP 49546
Phone 616 974-9792
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Pharmacy
Lab Director DAVID J. MILLER

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