52D2242185 CLIA NUMBER - WALGREENS #10714

Laboratory Demographics

  • CLIA Code: 52D2242185
  • Facility Name: WALGREENS #10714
  • Facility Address: 939 N WISCONSIN ST
    ELKHORN, WI
    ZIP 53121
  • Facility Phone: 262 723-5055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUELINE B. NORDVALL
  • NPI Number: 1487849477
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2242185
LAB Type Pharmacy
Facility Name WALGREENS #10714
Street 939 N WISCONSIN ST
City ELKHORN
State WI
ZIP 53121
Phone 262 723-5055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/5/2023
Certificate Expiration Date 11/4/2025
Facility Type Pharmacy
Lab Director JACQUELINE B. NORDVALL

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