24D2007689 CLIA NUMBER - WALGREENS 10289

Laboratory Demographics

  • CLIA Code: 24D2007689
  • Facility Name: WALGREENS 10289
  • Facility Address: 18267 CARSON CT NW
    ELK RIVER, MN
    ZIP 55330
  • Facility Phone: 763 252-1175
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BROOKE D. ROETHLER
  • NPI Number: 1477637742
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2007689
LAB Type Pharmacy
Facility Name WALGREENS 10289
Street 18267 CARSON CT NW
City ELK RIVER
State MN
ZIP 55330
Phone 763 252-1175
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2025
Certificate Expiration Date 8/21/2027
Facility Type Pharmacy
Lab Director BROOKE D. ROETHLER

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