52D2223054 CLIA NUMBER - WALGREENS #12020

Laboratory Demographics

CLIA Number: 52D2223054

Facility Name: WALGREENS #12020

Facility Address:
2702 CALUMET DR
SHEBOYGAN, WI
ZIP 53083
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Facility Phone Number: 920 457-5656

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093720997

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	52D2223054
LAB Type	Pharmacy
Facility Name	WALGREENS #12020
Street	2702 CALUMET DR
City	SHEBOYGAN
State	WI
ZIP	53083
Phone	920 457-5656
CertificateType	4
CertificateEffectiveDate	5/4/2023
CertificateExpirationDate	5/3/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024