52D2168694 CLIA NUMBER - RASMUSSEN VILLAGE PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 52D2168694
  • Facility Name: RASMUSSEN VILLAGE PHARMACY, INC
  • Facility Address: 840 MAIN STREET
    BALDWIN, WI
    ZIP 54002
  • Facility Phone: 715 684-2674
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN N. MELBY
  • NPI Number: 1609832500
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2168694
LAB Type Pharmacy
Facility Name RASMUSSEN VILLAGE PHARMACY, INC
Street 840 MAIN STREET
City BALDWIN
State WI
ZIP 54002
Phone 715 684-2674
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/8/2025
Certificate Expiration Date 7/7/2027
Facility Type Pharmacy
Lab Director KEVIN N. MELBY

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