52D2083956 CLIA NUMBER - WALGREENS #15637

Laboratory Demographics

  • CLIA Code: 52D2083956
  • Facility Name: WALGREENS #15637
  • Facility Address: 150 S WISCONSIN ST
    DE PERE, WI
    ZIP 54115
  • Facility Phone: 920 278-3241
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSIE BOECKMAN
  • NPI Number: 1871906503
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2083956
LAB Type Pharmacy
Facility Name WALGREENS #15637
Street 150 S WISCONSIN ST
City DE PERE
State WI
ZIP 54115
Phone 920 278-3241
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2025
Certificate Expiration Date 7/26/2027
Facility Type Pharmacy
Lab Director JESSIE BOECKMAN

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