52D2062795 CLIA NUMBER - WALGREENS #10234

Laboratory Demographics

  • CLIA Code: 52D2062795
  • Facility Name: WALGREENS #10234
  • Facility Address: 1305 N CASALOMA DR
    GRAND CHUTE, WI
    ZIP 54913
  • Facility Phone: 920 730-8218
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LUKE S. VANDERMAUSE
  • NPI Number: 1043225121
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2062795
LAB Type Pharmacy
Facility Name WALGREENS #10234
Street 1305 N CASALOMA DR
City GRAND CHUTE
State WI
ZIP 54913
Phone 920 730-8218
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Pharmacy
Lab Director LUKE S. VANDERMAUSE

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