23D2203199 CLIA NUMBER - PROFESSIONAL PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2203199
  • Facility Name: PROFESSIONAL PHARMACY
  • Facility Address: 9175 CHERRY VALLEY AVE SE
    CALEDONIA, MI
    ZIP 49316
  • Facility Phone: 616 891-1116
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISTIN J. RAREDON
  • NPI Number: 1992801625
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2203199
LAB Type Pharmacy
Facility Name PROFESSIONAL PHARMACY
Street 9175 CHERRY VALLEY AVE SE
City CALEDONIA
State MI
ZIP 49316
Phone 616 891-1116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/3/2024
Certificate Expiration Date 12/2/2026
Facility Type Pharmacy
Lab Director KRISTIN J. RAREDON

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