52D2184792 CLIA NUMBER - BENZER WI 1 LLC

Laboratory Demographics

  • CLIA Code: 52D2184792
  • Facility Name: BENZER WI 1 LLC
  • Facility Address: 1008 MAIN ST
    OCONTO, WI
    ZIP 54153
  • Facility Phone: 920 834-4455
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIDDHARTH PATEL
  • NPI Number: 1912997081
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2184792
LAB Type Pharmacy
Facility Name BENZER WI 1 LLC
Street 1008 MAIN ST
City OCONTO
State WI
ZIP 54153
Phone 920 834-4455
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2024
Certificate Expiration Date 5/25/2026
Facility Type Pharmacy
Lab Director SIDDHARTH PATEL

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