52D2217848 CLIA NUMBER - WALGREENS #03104

Laboratory Demographics

  • CLIA Code: 52D2217848
  • Facility Name: WALGREENS #03104
  • Facility Address: 2702 CALUMET AVE
    MANITOWOC, WI
    ZIP 54220
  • Facility Phone: 920 683-8887
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANNY WALTERS
  • NPI Number: 1306851456
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2217848
LAB Type Pharmacy
Facility Name WALGREENS #03104
Street 2702 CALUMET AVE
City MANITOWOC
State WI
ZIP 54220
Phone 920 683-8887
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 DANNY WALTERS

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