52D2015494 CLIA NUMBER - WALGREENS #11339

Laboratory Demographics

  • CLIA Code: 52D2015494
  • Facility Name: WALGREENS #11339
  • Facility Address: 116 N MILITARY AVE
    GREEN BAY, WI
    ZIP 54303
  • Facility Phone: 920 498-3247
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN DALTON
  • NPI Number: 1912180894
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2015494
LAB Type Pharmacy
Facility Name WALGREENS #11339
Street 116 N MILITARY AVE
City GREEN BAY
State WI
ZIP 54303
Phone 920 498-3247
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director JOHN DALTON

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