52D2014996 CLIA NUMBER - WALGREENS #03448

Laboratory Demographics

  • CLIA Code: 52D2014996
  • Facility Name: WALGREENS #03448
  • Facility Address: 11270 N PORT WASHINGTON RD
    MEQUON, WI
    ZIP 53092
  • Facility Phone: 262 241-5539
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEE PHA
  • NPI Number: 1376558437
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2014996
LAB Type Pharmacy
Facility Name WALGREENS #03448
Street 11270 N PORT WASHINGTON RD
City MEQUON
State WI
ZIP 53092
Phone 262 241-5539
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/4/2025
Certificate Expiration Date 2/3/2027
Facility Type Pharmacy
Lab Director LEE PHA

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