52D2219851 CLIA NUMBER - WALGREENS #11176

Laboratory Demographics

  • CLIA Code: 52D2219851
  • Facility Name: WALGREENS #11176
  • Facility Address: 812 N MAIN ST
    LAKE MILLS, WI
    ZIP 53551
  • Facility Phone: 920 648-5187
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HEATHER HUNT
  • NPI Number: 1467634709
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2219851
LAB Type Pharmacy
Facility Name WALGREENS #11176
Street 812 N MAIN ST
City LAKE MILLS
State WI
ZIP 53551
Phone 920 648-5187
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Pharmacy
Lab Director HEATHER HUNT

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