24D2011398 CLIA NUMBER - WALGREENS #07126

Laboratory Demographics

  • CLIA Code: 24D2011398
  • Facility Name: WALGREENS #07126
  • Facility Address: 4501 GRAND AVENUE
    DULUTH, MN
    ZIP 55807
  • Facility Phone: 218 628-2897
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMY L. FOSSUM
  • NPI Number: 1861407173
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/20/2023
Certificate Expiration Date 12/19/2025
Facility Type Pharmacy
Lab Director AMY L. FOSSUM

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