52D2220366 CLIA NUMBER - WALGREENS #11576

Laboratory Demographics

  • CLIA Code: 52D2220366
  • Facility Name: WALGREENS #11576
  • Facility Address: 1979 LIME KILN RD
    BELLEVUE, WI
    ZIP 54311
  • Facility Phone: 920 288-0638
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL CLARK
  • NPI Number: 1164603403
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2220366
LAB Type Pharmacy
Facility Name WALGREENS #11576
Street 1979 LIME KILN RD
City BELLEVUE
State WI
ZIP 54311
Phone 920 288-0638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/12/2025
Certificate Expiration Date 4/11/2027
Facility Type Pharmacy
Lab Director MICHAEL CLARK

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