24D2011194 CLIA NUMBER - WALGREENS 04879

Laboratory Demographics

  • CLIA Code: 24D2011194
  • Facility Name: WALGREENS 04879
  • Facility Address: 8100 W COUNTY ROAD 42
    SAVAGE, MN
    ZIP 55378
  • Facility Phone: 952 226-1283
  • Facility Type: Other - PHARMD 116970
  • Facility Type: Waiver
  • Lab Director: AMY L. MATIAK
  • NPI Number: 1205841426
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2011194
LAB Type Other - PHARMD 116970
Facility Name WALGREENS 04879
Street 8100 W COUNTY ROAD 42
City SAVAGE
State MN
ZIP 55378
Phone 952 226-1283
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Other - PHARMD 116970
Lab Director AMY L. MATIAK

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