52D2218405 CLIA NUMBER - WALGREENS #09682

Laboratory Demographics

  • CLIA Code: 52D2218405
  • Facility Name: WALGREENS #09682
  • Facility Address: 219 W MAIN ST
    LITTLE CHUTE, WI
    ZIP 54140
  • Facility Phone: 920 687-6193
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY CALDER
  • NPI Number: 1407861586
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2218405
LAB Type Pharmacy
Facility Name WALGREENS #09682
Street 219 W MAIN ST
City LITTLE CHUTE
State WI
ZIP 54140
Phone 920 687-6193
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/29/2025
Certificate Expiration Date 3/28/2027
Facility Type Pharmacy
Lab Director TIMOTHY CALDER

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