52D2217826 CLIA NUMBER - WALGREENS #13683

Laboratory Demographics

  • CLIA Code: 52D2217826
  • Facility Name: WALGREENS #13683
  • Facility Address: 1720 W WASHINGTON ST
    WEST BEND, WI
    ZIP 53095
  • Facility Phone: 262 438-1120
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY J. CLARK
  • NPI Number: 1598085367
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217826
LAB Type Pharmacy
Facility Name WALGREENS #13683
Street 1720 W WASHINGTON ST
City WEST BEND
State WI
ZIP 53095
Phone 262 438-1120
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 TIMOTHY J. CLARK

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