52D2182873 CLIA NUMBER - GWIDT PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2182873
  • Facility Name: GWIDT PHARMACY
  • Facility Address: 203 E WESTGOR AVE
    WITTENBERG, WI
    ZIP 54499
  • Facility Phone: 715 253-2164
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. SHANE L. RESCH
  • NPI Number: 1407861008
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2182873
LAB Type Pharmacy
Facility Name GWIDT PHARMACY
Street 203 E WESTGOR AVE
City WITTENBERG
State WI
ZIP 54499
Phone 715 253-2164
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Pharmacy
Lab Director MR. SHANE L. RESCH

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