24D2011398 CLIA NUMBER - WALGREENS #07126

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Laboratory Demographics

CLIA Number: 24D2011398

Facility Name: WALGREENS #07126

Facility Address:
4501 GRAND AVENUE
DULUTH, MN
ZIP 55807
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Facility Phone Number: 218 628-2897

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861407173

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	24D2011398
LAB Type	Pharmacy
Facility Name	WALGREENS #07126
Street	4501 GRAND AVENUE
City	DULUTH
State	MN
ZIP	55807
Phone	218 628-2897
CertificateType	4
CertificateEffectiveDate	12/20/2023
CertificateExpirationDate	12/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024