52D2288395 CLIA NUMBER - WALGREENS 02752

Laboratory Demographics

CLIA Number: 52D2288395

Facility Name: WALGREENS 02752

Facility Address:
15350 W BLUEMOUND RD
ELM GROVE, WI
ZIP 53122
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Facility Phone Number: 262 789-6819

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1316952468

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	52D2288395
LAB Type	Pharmacy
Facility Name	WALGREENS 02752
Street	15350 W BLUEMOUND RD
City	ELM GROVE
State	WI
ZIP	53122
Phone	262 789-6819
CertificateType	4
CertificateEffectiveDate	8/24/2023
CertificateExpirationDate	8/23/2025
FacilityType	Waiver

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