52D2269311 CLIA NUMBER - MONDOVI PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2269311
  • Facility Name: MONDOVI PHARMACY
  • Facility Address: 122 S EAU CLAIRE ST
    MONDOVI, WI
    ZIP 54755
  • Facility Phone: 715 926-4938
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICH MESTELLE
  • NPI Number: 1023110830
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2269311
LAB Type Pharmacy
Facility Name MONDOVI PHARMACY
Street 122 S EAU CLAIRE ST
City MONDOVI
State WI
ZIP 54755
Phone 715 926-4938
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Pharmacy
Lab Director RICH MESTELLE

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