52D2067836 CLIA NUMBER - WALGREENS 06569

Laboratory Demographics

  • CLIA Code: 52D2067836
  • Facility Name: WALGREENS 06569
  • Facility Address: 464 CARDINAL LN
    GREEN BAY, WI
    ZIP 54313
  • Facility Phone: 920 661-9355
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICHOLAS M. BOEGE
  • NPI Number: 1174538243
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2067836
LAB Type Pharmacy
Facility Name WALGREENS 06569
Street 464 CARDINAL LN
City GREEN BAY
State WI
ZIP 54313
Phone 920 661-9355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/2/2025
Certificate Expiration Date 10/1/2027
Facility Type Pharmacy
Lab Director NICHOLAS M. BOEGE

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