52D2184815 CLIA NUMBER - PLOVER HOMETOWN PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 52D2184815
  • Facility Name: PLOVER HOMETOWN PHARMACY LLC
  • Facility Address: 1600 AMERICAN DRIVE
    PLOVER, WI
    ZIP 54467
  • Facility Phone: 920 992-6800
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. KENT UDULUTCH
  • NPI Number: 1457919581
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2184815
LAB Type Pharmacy
Facility Name PLOVER HOMETOWN PHARMACY LLC
Street 1600 AMERICAN DRIVE
City PLOVER
State WI
ZIP 54467
Phone 920 992-6800
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 MR. KENT UDULUTCH

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