52D2231561 CLIA NUMBER - MORELAND PLAZA PHARMACY

Laboratory Demographics

CLIA Number: 52D2231561

Facility Name: MORELAND PLAZA PHARMACY

Facility Address:
827 W MORELAND BLVD
WAUKESHA, WI
ZIP 53188
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Facility Phone Number: 262 542-4488

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1821584343

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	52D2231561
LAB Type	Pharmacy
Facility Name	MORELAND PLAZA PHARMACY
Street	827 W MORELAND BLVD
City	WAUKESHA
State	WI
ZIP	53188
Phone	262 542-4488
CertificateType	4
CertificateEffectiveDate	8/4/2023
CertificateExpirationDate	8/3/2025
FacilityType	Waiver

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