52D2258903 CLIA NUMBER - WALMART PHARMACY 10-1365

Laboratory Demographics

  • CLIA Code: 52D2258903
  • Facility Name: WALMART PHARMACY 10-1365
  • Facility Address: 2222 CREST VIEW DR
    HUDSON, WI
    ZIP 54016
  • Facility Phone: 715 386-1345
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL GREMBAN
  • NPI Number: 1467479519
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2258903
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1365
Street 2222 CREST VIEW DR
City HUDSON
State WI
ZIP 54016
Phone 715 386-1345
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/28/2024
Certificate Expiration Date 4/27/2026
Facility Type Pharmacy
Lab Director MICHAEL GREMBAN

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