52D2218311 CLIA NUMBER - WALGREENS #10962

Laboratory Demographics

  • CLIA Code: 52D2218311
  • Facility Name: WALGREENS #10962
  • Facility Address: 1133 N JOHNS ST
    DODGEVILLE, WI
    ZIP 53533
  • Facility Phone: 608 935-2041
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT PROCKNOW
  • NPI Number: 1134336910
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2218311
LAB Type Pharmacy
Facility Name WALGREENS #10962
Street 1133 N JOHNS ST
City DODGEVILLE
State WI
ZIP 53533
Phone 608 935-2041
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 SCOTT PROCKNOW

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