52D2015490 CLIA NUMBER - WALGREENS #10496

Laboratory Demographics

  • CLIA Code: 52D2015490
  • Facility Name: WALGREENS #10496
  • Facility Address: 192 N MAIN ST
    FOND DU LAC, WI
    ZIP 54935
  • Facility Phone: 920 921-5264
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS M. SHEPPARD
  • NPI Number: 1649285537
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2015490
LAB Type Pharmacy
Facility Name WALGREENS #10496
Street 192 N MAIN ST
City FOND DU LAC
State WI
ZIP 54935
Phone 920 921-5264
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/22/2025
Certificate Expiration Date 9/21/2027
Facility Type Pharmacy
Lab Director THOMAS M. SHEPPARD

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