52D2217557 CLIA NUMBER - WALGREENS #09168

Laboratory Demographics

  • CLIA Code: 52D2217557
  • Facility Name: WALGREENS #09168
  • Facility Address: 710 W WISCONSIN AVE
    SPARTA, WI
    ZIP 54656
  • Facility Phone: 608 269-4031
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MATTHEW J. ENGLERTH
  • NPI Number: 1144235227
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217557
LAB Type Pharmacy
Facility Name WALGREENS #09168
Street 710 W WISCONSIN AVE
City SPARTA
State WI
ZIP 54656
Phone 608 269-4031
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 DR. MATTHEW J. ENGLERTH

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