52D2126389 CLIA NUMBER - CORNER DRUG HOMETOWN PHARMACY

Laboratory Demographics

CLIA Number: 52D2126389

Facility Name: CORNER DRUG HOMETOWN PHARMACY

Facility Address:
206 N IOWA STREET
DODGEVILLE, WI
ZIP 53533
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Facility Phone Number: 608 935-3661

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1992751143

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	52D2126389
LAB Type	Pharmacy
Facility Name	CORNER DRUG HOMETOWN PHARMACY
Street	206 N IOWA STREET
City	DODGEVILLE
State	WI
ZIP	53533
Phone	608 935-3661
CertificateType	4
CertificateEffectiveDate	2/27/2023
CertificateExpirationDate	2/26/2025
FacilityType	Waiver

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