52D2030426 CLIA NUMBER - WALGREENS #12545

Laboratory Demographics

  • CLIA Code: 52D2030426
  • Facility Name: WALGREENS #12545
  • Facility Address: 108 W WALL ST
    EAGLE RIVER, WI
    ZIP 54521
  • Facility Phone: 715 479-1069
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. JAY D. CHRISTOPHERSON
  • NPI Number: 1952537599
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2030426
LAB Type Pharmacy
Facility Name WALGREENS #12545
Street 108 W WALL ST
City EAGLE RIVER
State WI
ZIP 54521
Phone 715 479-1069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/7/2025
Certificate Expiration Date 4/6/2027
Facility Type Pharmacy
Lab Director MR. JAY D. CHRISTOPHERSON

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