52D2258156 CLIA NUMBER - WALMART PHARMACY 10-958

Laboratory Demographics

  • CLIA Code: 52D2258156
  • Facility Name: WALMART PHARMACY 10-958
  • Facility Address: 1800 PROGRESSIVE PKWY
    PLATTEVILLE, WI
    ZIP 53818
  • Facility Phone: 608 348-7809
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TODD KUDRONOWICZ
  • NPI Number: 1992722037
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2258156
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-958
Street 1800 PROGRESSIVE PKWY
City PLATTEVILLE
State WI
ZIP 53818
Phone 608 348-7809
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/18/2024
Certificate Expiration Date 4/17/2026
Facility Type Pharmacy
Lab Director TODD KUDRONOWICZ

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