24D2011693 CLIA NUMBER - WALGREENS #04725

Laboratory Demographics

  • CLIA Code: 24D2011693
  • Facility Name: WALGREENS #04725
  • Facility Address: 11401 MARKETPLACE DR N
    CHAMPLIN, MN
    ZIP 55316
  • Facility Phone: 763 427-6389
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JONATHAN M. CZECH
  • NPI Number: 1396750519
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2011693
LAB Type Pharmacy
Facility Name WALGREENS #04725
Street 11401 MARKETPLACE DR N
City CHAMPLIN
State MN
ZIP 55316
Phone 763 427-6389
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director JONATHAN M. CZECH

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