52D2218464 CLIA NUMBER - WALGREENS #05136

Laboratory Demographics

  • CLIA Code: 52D2218464
  • Facility Name: WALGREENS #05136
  • Facility Address: 301 W MAIN ST
    WATERTOWN, WI
    ZIP 53094
  • Facility Phone: 920 206-9588
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNY DONAR
  • NPI Number: 1740295641
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2218464
LAB Type Pharmacy
Facility Name WALGREENS #05136
Street 301 W MAIN ST
City WATERTOWN
State WI
ZIP 53094
Phone 920 206-9588
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 JENNY DONAR

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