52D2011829 CLIA NUMBER - WALGREENS #03578

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Laboratory Demographics

CLIA Number: 52D2011829

Facility Name: WALGREENS #03578

Facility Address:
2275 N MAYFAIR RD
WAUWATOSA, WI
ZIP 53226
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Facility Phone Number: 414 774-4821

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1275182925

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	52D2011829
LAB Type	Pharmacy
Facility Name	WALGREENS #03578
Street	2275 N MAYFAIR RD
City	WAUWATOSA
State	WI
ZIP	53226
Phone	414 774-4821
CertificateType	4
CertificateEffectiveDate	6/17/2023
CertificateExpirationDate	6/16/2025
FacilityType	Waiver

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