52D2209079 CLIA NUMBER - DEPERE HOMETOWN PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 52D2209079
  • Facility Name: DEPERE HOMETOWN PHARMACY LLC
  • Facility Address: 510 REDBIRD CIRCLE
    DE PERE, WI
    ZIP 54115
  • Facility Phone: 920 992-6800
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. SARAH BOWKER
  • NPI Number: 1730749672
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2209079
LAB Type Pharmacy
Facility Name DEPERE HOMETOWN PHARMACY LLC
Street 510 REDBIRD CIRCLE
City DE PERE
State WI
ZIP 54115
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 1/11/2025
Certificate Expiration Date 1/10/2027
Facility Type Pharmacy
Lab Director MS. SARAH BOWKER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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