23D2182455 CLIA NUMBER - LAKE ODESSA PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2182455
  • Facility Name: LAKE ODESSA PHARMACY
  • Facility Address: 802 4TH AVENUE
    LAKE ODESSA, MI
    ZIP 48849
  • Facility Phone: 877 855-9777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA R. CUSACK
  • NPI Number: 1831608108
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2182455
LAB Type Pharmacy
Facility Name LAKE ODESSA PHARMACY
Street 802 4TH AVENUE
City LAKE ODESSA
State MI
ZIP 48849
Phone 877 855-9777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2024
Certificate Expiration Date 4/21/2026
Facility Type Pharmacy
Lab Director ANDREA R. CUSACK

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