52D2224214 CLIA NUMBER - WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #08772

Laboratory Demographics

  • CLIA Code: 52D2224214
  • Facility Name: WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #08772
  • Facility Address: 5740 S PACKARD AVE
    CUDAHY, WI
    ZIP 53110
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MOHAMMED ELGHANNAM
  • NPI Number: 1346281219
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2224214
LAB Type Pharmacy
Facility Name WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #08772
Street 5740 S PACKARD AVE
City CUDAHY
State WI
ZIP 53110
Phone 866 389-2727
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 MOHAMMED ELGHANNAM

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