52D2125747 CLIA NUMBER - WAUPACA HOMETOWN PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2125747
  • Facility Name: WAUPACA HOMETOWN PHARMACY
  • Facility Address: 115 N WESTERN AVE UNIT 8
    WAUPACA, WI
    ZIP 54981
  • Facility Phone: 715 256-0400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. DENNISE ROSS
  • NPI Number: 1396087243
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2125747
LAB Type Pharmacy
Facility Name WAUPACA HOMETOWN PHARMACY
Street 115 N WESTERN AVE UNIT 8
City WAUPACA
State WI
ZIP 54981
Phone 715 256-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/13/2025
Certificate Expiration Date 2/12/2027
Facility Type Pharmacy
Lab Director MS. DENNISE ROSS

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