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52D2214839 CLIA NUMBER - WALGREENS #10196

Laboratory Demographics

CLIA Number: 52D2214839

Facility Name: WALGREENS #10196

Facility Address:
6600 W STATE STREET
WAUWATOSA, WI
ZIP 53213
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Facility Phone Number: 414 476-5585

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1437165875

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 52D2214839
LAB Type Pharmacy
Facility Name WALGREENS #10196
Street 6600 W STATE STREET
City WAUWATOSA
State WI
ZIP 53213
Phone 414 476-5585
CertificateType 4
CertificateEffectiveDate 2/25/2023
CertificateExpirationDate 2/24/2025
FacilityType Waiver

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