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