52D2269314 CLIA NUMBER - WALLY SHONG PHARMACY

Laboratory Demographics

  • CLIA Code: 52D2269314
  • Facility Name: WALLY SHONG PHARMACY
  • Facility Address: 153 W LINCOLN ST
    AUGUSTA, WI
    ZIP 54722
  • Facility Phone: 715 286-2515
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIANA ODAGARD
  • NPI Number: 1104928902
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 52D2269314
LAB Type Pharmacy
Facility Name WALLY SHONG PHARMACY
Street 153 W LINCOLN ST
City AUGUSTA
State WI
ZIP 54722
Phone 715 286-2515
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 DIANA ODAGARD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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