52D2200829 CLIA NUMBER - GWIDT PHARMACY INC DBA OCONTO FALLS PHARMACY

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Laboratory Demographics

CLIA Number: 52D2200829

Facility Name: GWIDT PHARMACY INC DBA OCONTO FALLS PHARMACY

Facility Address:
323 EAST HIGHLAND DR
OCONTO FALLS, WI
ZIP 54154
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Facility Phone Number: 920 848-3721

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245319912

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	52D2200829
LAB Type	Pharmacy
Facility Name	GWIDT PHARMACY INC DBA OCONTO FALLS PHARMACY
Street	323 EAST HIGHLAND DR
City	OCONTO FALLS
State	WI
ZIP	54154
Phone	920 848-3721
CertificateType	4
CertificateEffectiveDate	11/17/2022
CertificateExpirationDate	11/16/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024