52D0949680 CLIA NUMBER - LAKESHORE APOTHACARE INC

Laboratory Demographics

  • CLIA Code: 52D0949680
  • Facility Name: LAKESHORE APOTHACARE INC
  • Facility Address: 1500 WASHINGTON STREET
    TWO RIVERS, WI
    ZIP 54241
  • Facility Phone: 920 794-1225
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN C. JENSEN, RPH
  • NPI Number: 1568491413
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D0949680
LAB Type Pharmacy
Facility Name LAKESHORE APOTHACARE INC
Street 1500 WASHINGTON STREET
City TWO RIVERS
State WI
ZIP 54241
Phone 920 794-1225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/7/2024
Certificate Expiration Date 8/6/2026
Facility Type Pharmacy
Lab Director BRIAN C. JENSEN, RPH

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