52D2224273 CLIA NUMBER - WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #05535

Laboratory Demographics

CLIA Number: 52D2224273

Facility Name: WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #05535

Facility Address:
605 W COTTAGE GROVE
COTTAGE GROVE, WI
ZIP 53527
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1952678591

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	52D2224273
LAB Type	Pharmacy
Facility Name	WISCONSIN CVS PHARMACY LLC DBA CVS PHARMACY #05535
Street	605 W COTTAGE GROVE
City	COTTAGE GROVE
State	WI
ZIP	53527
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	Waiver

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