52D2019487 CLIA NUMBER - WALGREENS #10927

Laboratory Demographics

  • CLIA Code: 52D2019487
  • Facility Name: WALGREENS #10927
  • Facility Address: 20 W PIONEER RD
    FOND DU LAC, WI
    ZIP 54935
  • Facility Phone: 920 907-0556
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA PUCKER
  • NPI Number: 1649461252
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2019487
LAB Type Pharmacy
Facility Name WALGREENS #10927
Street 20 W PIONEER RD
City FOND DU LAC
State WI
ZIP 54935
Phone 920 907-0556
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Pharmacy
Lab Director KAYLA PUCKER

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