23D2188870 CLIA NUMBER - PHARMASOURCE LTC

Laboratory Demographics

  • CLIA Code: 23D2188870
  • Facility Name: PHARMASOURCE LTC
  • Facility Address: 31620 GRAND RIVER AVE
    FARMINGTON, MI
    ZIP 48336
  • Facility Phone: 734 261-4100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HANAN J. EL-SIBAI
  • NPI Number: 1043789431
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2188870
LAB Type Pharmacy
Facility Name PHARMASOURCE LTC
Street 31620 GRAND RIVER AVE
City FARMINGTON
State MI
ZIP 48336
Phone 734 261-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Pharmacy
Lab Director HANAN J. EL-SIBAI

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