24D2011403 CLIA NUMBER - WALGREENS #04260

Laboratory Demographics

  • CLIA Code: 24D2011403
  • Facility Name: WALGREENS #04260
  • Facility Address: 540 BLAKE RD N
    HOPKINS, MN
    ZIP 55343
  • Facility Phone: 952 938-1168
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARLOS D. SHANKS
  • NPI Number: 1780699090
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2011403
LAB Type Pharmacy
Facility Name WALGREENS #04260
Street 540 BLAKE RD N
City HOPKINS
State MN
ZIP 55343
Phone 952 938-1168
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director CARLOS D. SHANKS

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