24D2012102 CLIA NUMBER - WALGREENS #02767

Laboratory Demographics

  • CLIA Code: 24D2012102
  • Facility Name: WALGREENS #02767
  • Facility Address: 4005 VINEWOOD LN N
    PLYMOUTH, MN
    ZIP 55442
  • Facility Phone: 763 553-9731
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOSEPH D. CONWAY
  • NPI Number: 1679588990
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2012102
LAB Type Pharmacy
Facility Name WALGREENS #02767
Street 4005 VINEWOOD LN N
City PLYMOUTH
State MN
ZIP 55442
Phone 763 553-9731
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/28/2025
Certificate Expiration Date 6/27/2027
Facility Type Pharmacy
Lab Director JOSEPH D. CONWAY

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