23D2248042 CLIA NUMBER - CUSTOMCARE PHARMACY

Laboratory Demographics

  • CLIA Code: 23D2248042
  • Facility Name: CUSTOMCARE PHARMACY
  • Facility Address: 3535 W 13 MILE
    ROYAL OAK, MI
    ZIP 48073
  • Facility Phone: 248 551-8290
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEX DIKHOW
  • NPI Number: 1679645469
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 23D2248042
LAB Type Pharmacy
Facility Name CUSTOMCARE PHARMACY
Street 3535 W 13 MILE
City ROYAL OAK
State MI
ZIP 48073
Phone 248 551-8290
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/11/2024
Certificate Expiration Date 1/10/2026
Facility Type Pharmacy
Lab Director ALEX DIKHOW

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