16D2058699 CLIA NUMBER - WALGREENS #11759

Laboratory Demographics

  • CLIA Code: 16D2058699
  • Facility Name: WALGREENS #11759
  • Facility Address: 2639 AVENUE L
    FORT MADISON, IA
    ZIP 52627
  • Facility Phone: 319 372-8794
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL J. GRACEY
  • NPI Number: 1760620918
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 16D2058699
LAB Type Pharmacy
Facility Name WALGREENS #11759
Street 2639 AVENUE L
City FORT MADISON
State IA
ZIP 52627
Phone 319 372-8794
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director DANIEL J. GRACEY

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