52D2163993 CLIA NUMBER - KIMBERLY HOMETOWN PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2163993
  • Facility Name: KIMBERLY HOMETOWN PHARMACY
  • Facility Address: W 2721 BROOKHAVEN DR
    APPLETON, WI
    ZIP 54915
  • Facility Phone: 920 423-3438
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: OLABISI ORESEGUN
  • NPI Number: 1295291045
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2163993
LAB Type Pharmacy
Facility Name KIMBERLY HOMETOWN PHARMACY
Street W 2721 BROOKHAVEN DR
City APPLETON
State WI
ZIP 54915
Phone 920 423-3438
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Pharmacy
Lab Director OLABISI ORESEGUN

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