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52D2210979 CLIA NUMBER - WALGREENS #05309

Laboratory Demographics

CLIA Number: 52D2210979

Facility Name: WALGREENS #05309

Facility Address:
1441 CAPITOL DR
PEWAUKEE, WI
ZIP 53072
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Facility Phone Number: 262 695-3088

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1992710057

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 52D2210979
LAB Type Pharmacy
Facility Name WALGREENS #05309
Street 1441 CAPITOL DR
City PEWAUKEE
State WI
ZIP 53072
Phone 262 695-3088
CertificateType 4
CertificateEffectiveDate 1/25/2023
CertificateExpirationDate 1/24/2025
FacilityType Waiver

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