52D2219403 CLIA NUMBER - WALGREENS #10396

Laboratory Demographics

  • CLIA Code: 52D2219403
  • Facility Name: WALGREENS #10396
  • Facility Address: 1500 W JAMES ST
    COLUMBUS, WI
    ZIP 53925
  • Facility Phone: 920 623-5459
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENJAMIN T. SCHMIDT
  • NPI Number: 1689756157
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2219403
LAB Type Pharmacy
Facility Name WALGREENS #10396
Street 1500 W JAMES ST
City COLUMBUS
State WI
ZIP 53925
Phone 920 623-5459
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director BENJAMIN T. SCHMIDT

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