52D2280209 CLIA NUMBER - WISCONSIN CVS PHARMACY, LLC DBA CVS/PHARMACY #10411

Laboratory Demographics

CLIA Number: 52D2280209

Facility Name: WISCONSIN CVS PHARMACY, LLC DBA CVS/PHARMACY #10411

Facility Address:
433 BROADWAY STREET SOUTH
MENOMONIE, WI
ZIP 54751
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Facility Phone Number: 715 235-5349

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1780090415

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	52D2280209
LAB Type	Pharmacy
Facility Name	WISCONSIN CVS PHARMACY, LLC DBA CVS/PHARMACY #10411
Street	433 BROADWAY STREET SOUTH
City	MENOMONIE
State	WI
ZIP	54751
Phone	715 235-5349
CertificateType	4
CertificateEffectiveDate	4/14/2023
CertificateExpirationDate	4/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024