52D2183927 CLIA NUMBER - GOOD VALUE PHARMACY LARSEN-MAYER

Laboratory Demographics

  • CLIA Code: 52D2183927
  • Facility Name: GOOD VALUE PHARMACY LARSEN-MAYER
  • Facility Address: 3825 39TH AVE STE 100
    KENOSHA, WI
    ZIP 53144
  • Facility Phone: 262 658-8124
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. ALEX BERCE
  • NPI Number: 1174021778
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2183927
LAB Type Pharmacy
Facility Name GOOD VALUE PHARMACY LARSEN-MAYER
Street 3825 39TH AVE STE 100
City KENOSHA
State WI
ZIP 53144
Phone 262 658-8124
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2024
Certificate Expiration Date 5/11/2026
Facility Type Pharmacy
Lab Director MR. ALEX BERCE

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