52D2217798 CLIA NUMBER - WALGREENS #12021

Laboratory Demographics

  • CLIA Code: 52D2217798
  • Facility Name: WALGREENS #12021
  • Facility Address: 320 W SUMMIT AVE
    WALES, WI
    ZIP 53183
  • Facility Phone: 262 968-6900
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE MITCHELL
  • NPI Number: 1578891404
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217798
LAB Type Pharmacy
Facility Name WALGREENS #12021
Street 320 W SUMMIT AVE
City WALES
State WI
ZIP 53183
Phone 262 968-6900
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 MICHELLE MITCHELL

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This page was last updated on: 3/20/2025