52D2217552 CLIA NUMBER - WALGREENS #01497

Laboratory Demographics

  • CLIA Code: 52D2217552
  • Facility Name: WALGREENS #01497
  • Facility Address: 2455 EASTERN AVE
    PLYMOUTH, WI
    ZIP 53073
  • Facility Phone: 920 893-5895
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AHMED GAMAL
  • NPI Number: 1508871682
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217552
LAB Type Pharmacy
Facility Name WALGREENS #01497
Street 2455 EASTERN AVE
City PLYMOUTH
State WI
ZIP 53073
Phone 920 893-5895
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Pharmacy
Lab Director AHMED GAMAL

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