24D2007691 CLIA NUMBER - WALGREENS #11287

Laboratory Demographics

  • CLIA Code: 24D2007691
  • Facility Name: WALGREENS #11287
  • Facility Address: 10905 ULYSSES ST NE
    BLAINE, MN
    ZIP 55434
  • Facility Phone: 763 252-0687
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEFFREY SIMMONS
  • NPI Number: 1750566287
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2007691
LAB Type Pharmacy
Facility Name WALGREENS #11287
Street 10905 ULYSSES ST NE
City BLAINE
State MN
ZIP 55434
Phone 763 252-0687
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director JEFFREY SIMMONS

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