52D2288389 CLIA NUMBER - WALGREENS 11253

Laboratory Demographics

  • CLIA Code: 52D2288389
  • Facility Name: WALGREENS 11253
  • Facility Address: 607 PARK AVE
    BEAVER DAM, WI
    ZIP 53916
  • Facility Phone: 920 356-0148
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAMELA M. WEBB
  • NPI Number: 1124210166
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 52D2288389
LAB Type Pharmacy
Facility Name WALGREENS 11253
Street 607 PARK AVE
City BEAVER DAM
State WI
ZIP 53916
Phone 920 356-0148
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/24/2025
Certificate Expiration Date 8/23/2027
Facility Type Pharmacy
Lab Director PAMELA M. WEBB

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