52D2221766 CLIA NUMBER - WALGREENS #09699

Laboratory Demographics

  • CLIA Code: 52D2221766
  • Facility Name: WALGREENS #09699
  • Facility Address: 925 W FULTON ST
    WAUPACA, WI
    ZIP 54981
  • Facility Phone: 715 258-9228
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRADLEY J. BETTS
  • NPI Number: 1144235292
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2221766
LAB Type Pharmacy
Facility Name WALGREENS #09699
Street 925 W FULTON ST
City WAUPACA
State WI
ZIP 54981
Phone 715 258-9228
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director BRADLEY J. BETTS

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This page was last updated on: 6/4/2025