52D2065130 CLIA NUMBER - WALGREENS #04533

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Laboratory Demographics

CLIA Number: 52D2065130

Facility Name: WALGREENS #04533

Facility Address:
315 W MURDOCK AVE
OSHKOSH, WI
ZIP 54901
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Facility Phone Number: 920 231-8664

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1902811060

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	52D2065130
LAB Type	Pharmacy
Facility Name	WALGREENS #04533
Street	315 W MURDOCK AVE
City	OSHKOSH
State	WI
ZIP	54901
Phone	920 231-8664
CertificateType	4
CertificateEffectiveDate	2/22/2023
CertificateExpirationDate	2/21/2025
FacilityType	Waiver

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