52D2258171 CLIA NUMBER - WISCONSIN CVS PHARMACY, LLC DBAD CVS/PHARMACY #04380

Laboratory Demographics

  • CLIA Code: 52D2258171
  • Facility Name: WISCONSIN CVS PHARMACY, LLC DBAD CVS/PHARMACY #04380
  • Facility Address: 1736 W 9TH AVE
    OSHKOSH, WI
    ZIP 54902
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RYAN LUEDER
  • NPI Number: 1588702781
  • Taxonomy: 152W00000X - Optometrist

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CLIA Record

Field Name Field Value
CLIA Number 52D2258171
LAB Type Pharmacy
Facility Name WISCONSIN CVS PHARMACY, LLC DBAD CVS/PHARMACY #04380
Street 1736 W 9TH AVE
City OSHKOSH
State WI
ZIP 54902
Phone 866 389-2727
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 RYAN LUEDER

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