52D2019489 CLIA NUMBER - WALGREENS #07731

Laboratory Demographics

  • CLIA Code: 52D2019489
  • Facility Name: WALGREENS #07731
  • Facility Address: N65W25055 MAIN ST
    SUSSEX, WI
    ZIP 53089
  • Facility Phone: 262 820-0750
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHAN PHUONG DUONG
  • NPI Number: 1053326132
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2019489
LAB Type Pharmacy
Facility Name WALGREENS #07731
Street N65W25055 MAIN ST
City SUSSEX
State WI
ZIP 53089
Phone 262 820-0750
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2025
Certificate Expiration Date 6/16/2027
Facility Type Pharmacy
Lab Director CHAN PHUONG DUONG

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