52D2224140 CLIA NUMBER - WALGREENS #09605

Laboratory Demographics

  • CLIA Code: 52D2224140
  • Facility Name: WALGREENS #09605
  • Facility Address: 1810 30TH AVE
    KENOSHA, WI
    ZIP 53144
  • Facility Phone: 262 551-8812
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORDAN A. ANDERSON
  • NPI Number: 1225043375
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2224140
LAB Type Pharmacy
Facility Name WALGREENS #09605
Street 1810 30TH AVE
City KENOSHA
State WI
ZIP 53144
Phone 262 551-8812
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/12/2025
Certificate Expiration Date 5/11/2027
Facility Type Pharmacy
Lab Director JORDAN A. ANDERSON

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