52D2176746 CLIA NUMBER - WOODLAKE PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2176746
  • Facility Name: WOODLAKE PHARMACY
  • Facility Address: 765 WOODLAKE RD, SUITE G
    KOHLER, WI
    ZIP 53044
  • Facility Phone: 920 457-7644
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. DEBRA RUBACH
  • NPI Number: 1699796672
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2176746
LAB Type Pharmacy
Facility Name WOODLAKE PHARMACY
Street 765 WOODLAKE RD, SUITE G
City KOHLER
State WI
ZIP 53044
Phone 920 457-7644
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/23/2023
Certificate Expiration Date 12/22/2025
Facility Type Pharmacy
Lab Director MS. DEBRA RUBACH

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