52D0949954 CLIA NUMBER - GOOD VALUE PHARMACY

Laboratory Demographics

  • CLIA Code: 52D0949954
  • Facility Name: GOOD VALUE PHARMACY
  • Facility Address: 3207 80TH ST STE 100
    KENOSHA, WI
    ZIP 53142
  • Facility Phone: 262 697-5744
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHILIP T. BERCE, RPH
  • NPI Number: 1689744286
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D0949954
LAB Type Pharmacy
Facility Name GOOD VALUE PHARMACY
Street 3207 80TH ST STE 100
City KENOSHA
State WI
ZIP 53142
Phone 262 697-5744
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2024
Certificate Expiration Date 8/13/2026
Facility Type Pharmacy
Lab Director PHILIP T. BERCE, RPH

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