24D2031265 CLIA NUMBER - WALGREENS #13903

Laboratory Demographics

  • CLIA Code: 24D2031265
  • Facility Name: WALGREENS #13903
  • Facility Address: 101 MAIN AVE N
    PARK RAPIDS, MN
    ZIP 56470
  • Facility Phone: 218 732-3342
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CARLY J. BLACK
  • NPI Number: 1780915397
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2031265
LAB Type Pharmacy
Facility Name WALGREENS #13903
Street 101 MAIN AVE N
City PARK RAPIDS
State MN
ZIP 56470
Phone 218 732-3342
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/26/2025
Certificate Expiration Date 5/25/2027
Facility Type Pharmacy
Lab Director CARLY J. BLACK

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