24D2019368 CLIA NUMBER - WALGREENS #12972

Laboratory Demographics

  • CLIA Code: 24D2019368
  • Facility Name: WALGREENS #12972
  • Facility Address: 100 CHALUPSKY AVE SE
    NEW PRAGUE, MN
    ZIP 56071
  • Facility Phone: 952 758-8855
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TIMOTHY OLSON
  • NPI Number: 1477882686
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2019368
LAB Type Pharmacy
Facility Name WALGREENS #12972
Street 100 CHALUPSKY AVE SE
City NEW PRAGUE
State MN
ZIP 56071
Phone 952 758-8855
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director TIMOTHY OLSON

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