52D2218255 CLIA NUMBER - WALGREENS #11648

Laboratory Demographics

  • CLIA Code: 52D2218255
  • Facility Name: WALGREENS #11648
  • Facility Address: 1401 SPRINGDALE ST
    MOUNT HOREB, WI
    ZIP 53572
  • Facility Phone: 608 437-9160
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA KRAUSE
  • NPI Number: 1528243276
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2218255
LAB Type Pharmacy
Facility Name WALGREENS #11648
Street 1401 SPRINGDALE ST
City MOUNT HOREB
State WI
ZIP 53572
Phone 608 437-9160
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/26/2025
Certificate Expiration Date 3/25/2027
Facility Type Pharmacy
Lab Director AMANDA KRAUSE

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