52D2230775 CLIA NUMBER - WALGREENS #05102

Laboratory Demographics

CLIA Number: 52D2230775

Facility Name: WALGREENS #05102

Facility Address:
700 W COLLEGE AVE
APPLETON, WI
ZIP 54914
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Facility Phone Number: 920 733-6599

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1043225196

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	52D2230775
LAB Type	Pharmacy
Facility Name	WALGREENS #05102
Street	700 W COLLEGE AVE
City	APPLETON
State	WI
ZIP	54914
Phone	920 733-6599
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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