52D2217794 CLIA NUMBER - WALGREENS #11649

Laboratory Demographics

  • CLIA Code: 52D2217794
  • Facility Name: WALGREENS #11649
  • Facility Address: 999 E MAIN ST
    WAUPUN, WI
    ZIP 53963
  • Facility Phone: 920 324-4696
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DILLON N. ABHOLD
  • NPI Number: 1013178367
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217794
LAB Type Pharmacy
Facility Name WALGREENS #11649
Street 999 E MAIN ST
City WAUPUN
State WI
ZIP 53963
Phone 920 324-4696
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director DILLON N. ABHOLD

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