23D2072596 CLIA NUMBER - WALGREENS #15650

Laboratory Demographics

  • CLIA Code: 23D2072596
  • Facility Name: WALGREENS #15650
  • Facility Address: 317 S STATE STREET
    ANN ARBOR, MI
    ZIP 48104
  • Facility Phone: 734 352-3623
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MIKAH A. PEDERSOLI
  • NPI Number: 1871924902
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2072596
LAB Type Pharmacy
Facility Name WALGREENS #15650
Street 317 S STATE STREET
City ANN ARBOR
State MI
ZIP 48104
Phone 734 352-3623
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2025
Certificate Expiration Date 8/15/2027
Facility Type Pharmacy
Lab Director MIKAH A. PEDERSOLI

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