24D2007696 CLIA NUMBER - WALGREENS #11250

Laboratory Demographics

  • CLIA Code: 24D2007696
  • Facility Name: WALGREENS #11250
  • Facility Address: 3913 W OLD SHAKOPEE RD
    BLOOMINGTON, MN
    ZIP 55437
  • Facility Phone: 952 252-1062
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HERVE BERTRAND K. MBAKAM
  • NPI Number: 1841424926
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2007696
LAB Type Pharmacy
Facility Name WALGREENS #11250
Street 3913 W OLD SHAKOPEE RD
City BLOOMINGTON
State MN
ZIP 55437
Phone 952 252-1062
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/23/2025
Certificate Expiration Date 4/22/2027
Facility Type Pharmacy
Lab Director HERVE BERTRAND K. MBAKAM

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