24D2011685 CLIA NUMBER - WALGREENS 04119

Laboratory Demographics

  • CLIA Code: 24D2011685
  • Facility Name: WALGREENS 04119
  • Facility Address: 4547 HIAWATHA AVENUE
    MINNEAPOLIS, MN
    ZIP 55406
  • Facility Phone: 612 722-4249
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN JAMES POWERS III
  • NPI Number: 1174539712
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2011685
LAB Type Pharmacy
Facility Name WALGREENS 04119
Street 4547 HIAWATHA AVENUE
City MINNEAPOLIS
State MN
ZIP 55406
Phone 612 722-4249
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/22/2023
Certificate Expiration Date 8/21/2025
Facility Type Pharmacy
Lab Director JOHN JAMES POWERS III

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This page was last updated on: 3/20/2025