52D2015171 CLIA NUMBER - WALGREENS #03567

Laboratory Demographics

  • CLIA Code: 52D2015171
  • Facility Name: WALGREENS #03567
  • Facility Address: 1021 SUMMIT AVE
    OCONOMOWOC, WI
    ZIP 53066
  • Facility Phone: 262 567-9173
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GENESIS G. GIRMSCHEID
  • NPI Number: 1285649178
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2015171
LAB Type Pharmacy
Facility Name WALGREENS #03567
Street 1021 SUMMIT AVE
City OCONOMOWOC
State WI
ZIP 53066
Phone 262 567-9173
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/16/2025
Certificate Expiration Date 4/15/2027
Facility Type Pharmacy
Lab Director GENESIS G. GIRMSCHEID

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