52D2231114 CLIA NUMBER - WALGREENS #04253

Laboratory Demographics

CLIA Number: 52D2231114

Facility Name: WALGREENS #04253

Facility Address:
2656 N WAUWATOSA AVE
WAUWATOSA, WI
ZIP 53213
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Facility Phone Number: 414 453-9630

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1912912809

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	52D2231114
LAB Type	Pharmacy
Facility Name	WALGREENS #04253
Street	2656 N WAUWATOSA AVE
City	WAUWATOSA
State	WI
ZIP	53213
Phone	414 453-9630
CertificateType	4
CertificateEffectiveDate	7/30/2023
CertificateExpirationDate	7/29/2025
FacilityType	Waiver

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