52D2217836 CLIA NUMBER - WALGREENS #11676

Laboratory Demographics

  • CLIA Code: 52D2217836
  • Facility Name: WALGREENS #11676
  • Facility Address: N168W21330 MAIN ST
    JACKSON, WI
    ZIP 53037
  • Facility Phone: 262 677-1702
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHAN PHUONG DUONG
  • NPI Number: 1538347232
  • Taxonomy: 333600000X - Pharmacy

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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
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 CHAN PHUONG DUONG

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