23D2139754 CLIA NUMBER - FRED'S SUPER-PHARMACY INC

Laboratory Demographics

  • CLIA Code: 23D2139754
  • Facility Name: FRED'S SUPER-PHARMACY INC
  • Facility Address: 121 W PRAIRIE STREET
    VICKSBURG, MI
    ZIP 49097
  • Facility Phone: 269 649-0660
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ELAINE A. OESTRIKE
  • NPI Number: 1902882426
  • Taxonomy: 183500000X - Pharmacist

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 23D2139754
LAB Type Pharmacy
Facility Name FRED'S SUPER-PHARMACY INC
Street 121 W PRAIRIE STREET
City VICKSBURG
State MI
ZIP 49097
Phone 269 649-0660
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/8/2023
Certificate Expiration Date 11/7/2025
Facility Type Pharmacy
Lab Director ELAINE A. OESTRIKE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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