52D2058842 CLIA NUMBER - WALGREENS #03615

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Laboratory Demographics

CLIA Number: 52D2058842

Facility Name: WALGREENS #03615

Facility Address:
21325 E MORELAND BLVD
WAUKESHA, WI
ZIP 53186
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Facility Phone Number: 262 798-0223

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1023023173

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	52D2058842
LAB Type	Pharmacy
Facility Name	WALGREENS #03615
Street	21325 E MORELAND BLVD
City	WAUKESHA
State	WI
ZIP	53186
Phone	262 798-0223
CertificateType	4
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	Waiver

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