52D2096928 CLIA NUMBER - MEIJER PHARMACY #277

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Laboratory Demographics

CLIA Number: 52D2096928

Facility Name: MEIJER PHARMACY #277

Facility Address:
11111 W BURLEIGH ST
WAUWATOSA, WI
ZIP 53222
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Facility Phone Number: 414 290-0910

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093195596

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	52D2096928
LAB Type	Pharmacy
Facility Name	MEIJER PHARMACY #277
Street	11111 W BURLEIGH ST
City	WAUWATOSA
State	WI
ZIP	53222
Phone	414 290-0910
CertificateType	4
CertificateEffectiveDate	6/4/2023
CertificateExpirationDate	6/3/2025
FacilityType	Waiver

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