52D2217836 CLIA NUMBER - WALGREENS #11676

Laboratory Demographics

CLIA Number: 52D2217836

Facility Name: WALGREENS #11676

Facility Address:
N168W21330 MAIN ST
JACKSON, WI
ZIP 53037
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Facility Phone Number: 262 677-1702

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1538347232

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	52D2217836
LAB Type	Pharmacy
Facility Name	WALGREENS #11676
Street	N168W21330 MAIN ST
City	JACKSON
State	WI
ZIP	53037
Phone	262 677-1702
CertificateType	4
CertificateEffectiveDate	3/24/2023
CertificateExpirationDate	3/23/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024