52D2217761 CLIA NUMBER - WALGREENS #03115

Laboratory Demographics

  • CLIA Code: 52D2217761
  • Facility Name: WALGREENS #03115
  • Facility Address: 1165 W MASON ST
    GREEN BAY, WI
    ZIP 54303
  • Facility Phone: 920 498-3794
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN DORNER
  • NPI Number: 1932114089
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217761
LAB Type Pharmacy
Facility Name WALGREENS #03115
Street 1165 W MASON ST
City GREEN BAY
State WI
ZIP 54303
Phone 920 498-3794
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/23/2025
Certificate Expiration Date 3/22/2027
Facility Type Pharmacy
Lab Director JOHN DORNER

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