52D2230775 CLIA NUMBER - WALGREENS #05102

Laboratory Demographics

  • CLIA Code: 52D2230775
  • Facility Name: WALGREENS #05102
  • Facility Address: 700 W COLLEGE AVE
    APPLETON, WI
    ZIP 54914
  • Facility Phone: 920 733-6599
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEPH F. GRYCOWSKI
  • NPI Number: 1043225196
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/28/2025
Certificate Expiration Date 7/27/2027
Facility Type Pharmacy
Lab Director JOSEPH F. GRYCOWSKI

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