52D2240415 CLIA NUMBER - WALGREENS #05417

Laboratory Demographics

  • CLIA Code: 52D2240415
  • Facility Name: WALGREENS #05417
  • Facility Address: 6125 DURAND AVE
    MOUNT PLEASANT, WI
    ZIP 53406
  • Facility Phone: 262 554-6116
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MACKENZIE SPLITT
  • NPI Number: 1194092932
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2240415
LAB Type Pharmacy
Facility Name WALGREENS #05417
Street 6125 DURAND AVE
City MOUNT PLEASANT
State WI
ZIP 53406
Phone 262 554-6116
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Pharmacy
Lab Director MACKENZIE SPLITT

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