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52D2126972 CLIA NUMBER - MEIJER PHARMACY #299

Laboratory Demographics

CLIA Number: 52D2126972

Facility Name: MEIJER PHARMACY #299

Facility Address:
2180 SOUTH MAIN STREET
WEST BEND, WI
ZIP 53095
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Facility Phone Number: 262 334-8510

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1396280160

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 52D2126972
LAB Type Pharmacy
Facility Name MEIJER PHARMACY #299
Street 2180 SOUTH MAIN STREET
City WEST BEND
State WI
ZIP 53095
Phone 262 334-8510
CertificateType 4
CertificateEffectiveDate 3/8/2023
CertificateExpirationDate 3/7/2025
FacilityType Waiver

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