52D2033329 CLIA NUMBER - WALGREENS #11857

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Laboratory Demographics

CLIA Number: 52D2033329

Facility Name: WALGREENS #11857

Facility Address:
10489 STATE ROAD 27
HAYWARD, WI
ZIP 54843
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Facility Phone Number: 715 634-1919

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1356505044

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	52D2033329
LAB Type	Pharmacy
Facility Name	WALGREENS #11857
Street	10489 STATE ROAD 27
City	HAYWARD
State	WI
ZIP	54843
Phone	715 634-1919
CertificateType	4
CertificateEffectiveDate	3/29/2023
CertificateExpirationDate	3/28/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024