52D0716936 CLIA NUMBER - BOSCOBEL PHARMACY INC

Laboratory Demographics

CLIA Number: 52D0716936

Facility Name: BOSCOBEL PHARMACY INC

Facility Address:
1028 WISCONSIN AVENUE
BOSCOBEL, WI
ZIP 53805
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Facility Phone Number: 608 375-4466

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245249614

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 52D0716936
LAB Type Pharmacy
Facility Name BOSCOBEL PHARMACY INC
Street 1028 WISCONSIN AVENUE
City BOSCOBEL
State WI
ZIP 53805
Phone 608 375-4466
CertificateType 4
CertificateEffectiveDate 9/1/2022
CertificateExpirationDate 8/31/2024
FacilityType Waiver

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