52D2084681 CLIA NUMBER - MODERN APOTHECARY

Laboratory Demographics

  • CLIA Code: 52D2084681
  • Facility Name: MODERN APOTHECARY
  • Facility Address: 5700 6TH AVE
    KENOSHA, WI
    ZIP 53140
  • Facility Phone: 262 997-9573
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. ERIN E. MERRITT
  • NPI Number: 1407265598
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2084681
LAB Type Pharmacy
Facility Name MODERN APOTHECARY
Street 5700 6TH AVE
City KENOSHA
State WI
ZIP 53140
Phone 262 997-9573
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2024
Certificate Expiration Date 5/6/2026
Facility Type Pharmacy
Lab Director DR. ERIN E. MERRITT

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