23D2186732 CLIA NUMBER - RITE AID #4694

Laboratory Demographics

CLIA Number: 23D2186732

Facility Name: RITE AID #4694

Facility Address:
19150 WYOMING STREET
DETROIT, MI
ZIP 48221
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Facility Phone Number: 313 341-9700

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1083638662

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	23D2186732
LAB Type	Pharmacy
Facility Name	RITE AID #4694
Street	19150 WYOMING STREET
City	DETROIT
State	MI
ZIP	48221
Phone	313 341-9700
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