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

Laboratory Demographics

  • CLIA Code: 52D2200829
  • Facility Name: GWIDT PHARMACY INC DBA OCONTO FALLS PHARMACY
  • Facility Address: 323 EAST HIGHLAND DR
    OCONTO FALLS, WI
    ZIP 54154
  • Facility Phone: 920 848-3721
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. TIMOTHY P. STARRY
  • NPI Number: 1245319912
  • Taxonomy: 3336C0003X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/17/2024
Certificate Expiration Date 11/16/2026
Facility Type Pharmacy
Lab Director MR. TIMOTHY P. STARRY

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