24D2007692 CLIA NUMBER - WALGREENS #01002

Laboratory Demographics

  • CLIA Code: 24D2007692
  • Facility Name: WALGREENS #01002
  • Facility Address: 3255 VICKSBURG LN N
    PLYMOUTH, MN
    ZIP 55447
  • Facility Phone: 763 253-8917
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA J. SELSETH
  • NPI Number: 1477568608
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2007692
LAB Type Pharmacy
Facility Name WALGREENS #01002
Street 3255 VICKSBURG LN N
City PLYMOUTH
State MN
ZIP 55447
Phone 763 253-8917
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/10/2025
Certificate Expiration Date 8/9/2027
Facility Type Pharmacy
Lab Director AMANDA J. SELSETH

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