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23D2286094 CLIA NUMBER - COSTCO PHARMACY #1420

Laboratory Demographics

CLIA Number: 23D2286094

Facility Name: COSTCO PHARMACY #1420

Facility Address:
4816 BAY CITY ROAD
MIDLAND, MI
ZIP 48642
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Facility Phone Number: 425 313-6772

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1982216651

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 23D2286094
LAB Type Pharmacy
Facility Name COSTCO PHARMACY #1420
Street 4816 BAY CITY ROAD
City MIDLAND
State MI
ZIP 48642
Phone 425 313-6772
CertificateType 4
CertificateEffectiveDate 7/24/2023
CertificateExpirationDate 7/23/2025
FacilityType Waiver

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