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52D2125749 CLIA NUMBER - WAUNAKEE HOMETOWN PHARMACY

Laboratory Demographics

CLIA Number: 52D2125749

Facility Name: WAUNAKEE HOMETOWN PHARMACY

Facility Address:
235 SOUTH CENTURY AVENUE
WAUNAKEE, WI
ZIP 53597
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Facility Phone Number: 608 850-9314

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1053862318

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 52D2125749
LAB Type Pharmacy
Facility Name WAUNAKEE HOMETOWN PHARMACY
Street 235 SOUTH CENTURY AVENUE
City WAUNAKEE
State WI
ZIP 53597
Phone 608 850-9314
CertificateType 4
CertificateEffectiveDate 2/13/2023
CertificateExpirationDate 2/12/2025
FacilityType Waiver

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