24D2007688 CLIA NUMBER - WALGREENS #01479

Laboratory Demographics

  • CLIA Code: 24D2007688
  • Facility Name: WALGREENS #01479
  • Facility Address: 16750 COUNTY ROAD 30
    MAPLE GROVE, MN
    ZIP 55311
  • Facility Phone: 763 416-1863
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL R. FORBROOK
  • NPI Number: 1780721886
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2007688
LAB Type Pharmacy
Facility Name WALGREENS #01479
Street 16750 COUNTY ROAD 30
City MAPLE GROVE
State MN
ZIP 55311
Phone 763 416-1863
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/17/2024
Certificate Expiration Date 12/16/2026
Facility Type Pharmacy
Lab Director MICHAEL R. FORBROOK

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This page was last updated on: 6/4/2025