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52D0996919 CLIA NUMBER - WALGREENS STORE #03109

Laboratory Demographics

CLIA Number: 52D0996919

Facility Name: WALGREENS STORE #03109

Facility Address:
7171 N TEUTONIA AVE
MILWAUKEE, WI
ZIP 53209
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Facility Phone Number: 414 351-2538

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1801803796

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 52D0996919
LAB Type Pharmacy
Facility Name WALGREENS STORE #03109
Street 7171 N TEUTONIA AVE
City MILWAUKEE
State WI
ZIP 53209
Phone 414 351-2538
CertificateType 4
CertificateEffectiveDate 12/19/2023
CertificateExpirationDate 12/18/2025
FacilityType Waiver

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