52D2012113 CLIA NUMBER - WALGREENS #03088

Laboratory Demographics

  • CLIA Code: 52D2012113
  • Facility Name: WALGREENS #03088
  • Facility Address: 1401 E MASON ST
    GREEN BAY, WI
    ZIP 54301
  • Facility Phone: 920 435-7679
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JO LUSARDI
  • NPI Number: 1689164725
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2012113
LAB Type Pharmacy
Facility Name WALGREENS #03088
Street 1401 E MASON ST
City GREEN BAY
State WI
ZIP 54301
Phone 920 435-7679
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/19/2025
Certificate Expiration Date 3/18/2027
Facility Type Pharmacy
Lab Director JO LUSARDI

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