23D2186716 CLIA NUMBER - RITE AID #4574

Laboratory Demographics

CLIA Number: 23D2186716

Facility Name: RITE AID #4574

Facility Address:
2910 PINE GROVE AVENUE
PORT HURON, MI
ZIP 48060
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Facility Phone Number: 810 987-3663

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1679585376

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	23D2186716
LAB Type	Pharmacy
Facility Name	RITE AID #4574
Street	2910 PINE GROVE AVENUE
City	PORT HURON
State	MI
ZIP	48060
Phone	810 987-3663
CertificateType	4
CertificateEffectiveDate	6/22/2022
CertificateExpirationDate	6/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024