23D2184101 CLIA NUMBER - PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2184101
  • Facility Name: PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY
  • Facility Address: 4665 44TH STREET SE SUITE A 1106
    GRAND RAPIDS, MI
    ZIP 49512
  • Facility Phone: 616 977-9700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS MOODY
  • NPI Number: 1083849640
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2184101
LAB Type Pharmacy
Facility Name PCA CORRECTIONS, LLC DBA SYNCHRONY GRAND RAPIDS PHARMACY
Street 4665 44TH STREET SE SUITE A 1106
City GRAND RAPIDS
State MI
ZIP 49512
Phone 616 977-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/14/2024
Certificate Expiration Date 5/13/2026
Facility Type Pharmacy
Lab Director NICHOLAS MOODY

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