52D2287407 CLIA NUMBER - WALGREENS 04155

Laboratory Demographics

  • CLIA Code: 52D2287407
  • Facility Name: WALGREENS 04155
  • Facility Address: 15 E MAIN ST
    MADISON, WI
    ZIP 53703
  • Facility Phone: 608 257-3814
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAIMIE C. GOECKS
  • NPI Number: 1922013820
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2287407
LAB Type Pharmacy
Facility Name WALGREENS 04155
Street 15 E MAIN ST
City MADISON
State WI
ZIP 53703
Phone 608 257-3814
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director JAIMIE C. GOECKS

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