52D2059520 CLIA NUMBER - WALGREENS #09740

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Laboratory Demographics

CLIA Number: 52D2059520

Facility Name: WALGREENS #09740

Facility Address:
807 S MAIN ST
DE FOREST, WI
ZIP 53532
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Facility Phone Number: 608 846-3671

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1871508952

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	52D2059520
LAB Type	Pharmacy
Facility Name	WALGREENS #09740
Street	807 S MAIN ST
City	DE FOREST
State	WI
ZIP	53532
Phone	608 846-3671
CertificateType	4
CertificateEffectiveDate	3/26/2023
CertificateExpirationDate	3/25/2025
FacilityType	Waiver

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