52D2218680 CLIA NUMBER - WALGREENS #10235

Laboratory Demographics

  • CLIA Code: 52D2218680
  • Facility Name: WALGREENS #10235
  • Facility Address: 901 MAIN AVE
    DE PERE, WI
    ZIP 54115
  • Facility Phone: 920 983-6153
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRISHNA BAGALE
  • NPI Number: 1457398273
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2218680
LAB Type Pharmacy
Facility Name WALGREENS #10235
Street 901 MAIN AVE
City DE PERE
State WI
ZIP 54115
Phone 920 983-6153
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Pharmacy
Lab Director KRISHNA BAGALE

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