52D2209376 CLIA NUMBER - WALGREENS #12455

Laboratory Demographics

  • CLIA Code: 52D2209376
  • Facility Name: WALGREENS #12455
  • Facility Address: 3909 MORMON COULEE RD
    LA CROSSE, WI
    ZIP 54601
  • Facility Phone: 608 788-9700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KARAN V. SHAH
  • NPI Number: 1114257706
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2209376
LAB Type Pharmacy
Facility Name WALGREENS #12455
Street 3909 MORMON COULEE RD
City LA CROSSE
State WI
ZIP 54601
Phone 608 788-9700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2025
Certificate Expiration Date 1/12/2027
Facility Type Pharmacy
Lab Director KARAN V. SHAH

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: 6/4/2025