52D2118398 CLIA NUMBER - MARKETPLACE PHARMACY #2583

Laboratory Demographics

  • CLIA Code: 52D2118398
  • Facility Name: MARKETPLACE PHARMACY #2583
  • Facility Address: 10514 S MAIN ST
    HAYWARD, WI
    ZIP 54843
  • Facility Phone: 715 634-1817
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON D. MILLER
  • NPI Number: 1003260969
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2118398
LAB Type Pharmacy
Facility Name MARKETPLACE PHARMACY #2583
Street 10514 S MAIN ST
City HAYWARD
State WI
ZIP 54843
Phone 715 634-1817
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2024
Certificate Expiration Date 9/6/2026
Facility Type Pharmacy
Lab Director JASON D. MILLER

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