52D2124241 CLIA NUMBER - BEAVER DAM HOMETOWN PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2124241
  • Facility Name: BEAVER DAM HOMETOWN PHARMACY
  • Facility Address: 609 N SPRING ST
    BEAVER DAM, WI
    ZIP 53916
  • Facility Phone: 920 992-6800
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIN WILLIAMS
  • NPI Number: 1588036826
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2124241
LAB Type Pharmacy
Facility Name BEAVER DAM HOMETOWN PHARMACY
Street 609 N SPRING ST
City BEAVER DAM
State WI
ZIP 53916
Phone 920 992-6800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/12/2025
Certificate Expiration Date 1/11/2027
Facility Type Pharmacy
Lab Director ERIN WILLIAMS

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