52D2217805 CLIA NUMBER - WALGREENS #13065

Laboratory Demographics

  • CLIA Code: 52D2217805
  • Facility Name: WALGREENS #13065
  • Facility Address: 245 W CALUMET ST
    CHILTON, WI
    ZIP 53014
  • Facility Phone: 920 849-2818
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAMELA SEABOURNE
  • NPI Number: 1043548977
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217805
LAB Type Pharmacy
Facility Name WALGREENS #13065
Street 245 W CALUMET ST
City CHILTON
State WI
ZIP 53014
Phone 920 849-2818
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 TAMELA SEABOURNE

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