52D2225480 CLIA NUMBER - WALGREENS #02967

Laboratory Demographics

  • CLIA Code: 52D2225480
  • Facility Name: WALGREENS #02967
  • Facility Address: 1725 NORTHPORT DR
    MADISON, WI
    ZIP 53704
  • Facility Phone: 608 241-7001
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIELLE M. DIETZ
  • NPI Number: 1194732081
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2225480
LAB Type Pharmacy
Facility Name WALGREENS #02967
Street 1725 NORTHPORT DR
City MADISON
State WI
ZIP 53704
Phone 608 241-7001
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/21/2025
Certificate Expiration Date 5/20/2027
Facility Type Pharmacy
Lab Director DANIELLE M. DIETZ

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