24D2011687 CLIA NUMBER - WALGREENS 02935

Laboratory Demographics

  • CLIA Code: 24D2011687
  • Facility Name: WALGREENS 02935
  • Facility Address: 10686 UNIVERSITY AVE NW
    COON RAPIDS, MN
    ZIP 55448
  • Facility Phone: 763 755-1259
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRADLEY E. ROTE
  • NPI Number: 1114932431
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2011687
LAB Type Pharmacy
Facility Name WALGREENS 02935
Street 10686 UNIVERSITY AVE NW
City COON RAPIDS
State MN
ZIP 55448
Phone 763 755-1259
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/14/2025
Certificate Expiration Date 8/13/2027
Facility Type Pharmacy
Lab Director BRADLEY E. ROTE

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