24D2054860 CLIA NUMBER - THRIFTY WHITE PHARMACY #728

Laboratory Demographics

  • CLIA Code: 24D2054860
  • Facility Name: THRIFTY WHITE PHARMACY #728
  • Facility Address: 1105 SOUTH POKEGAMA AVENUE
    GRAND RAPIDS, MN
    ZIP 55744
  • Facility Phone: 218 326-9431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HANNAH MITTET
  • NPI Number: 1235228834
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2054860
LAB Type Pharmacy
Facility Name THRIFTY WHITE PHARMACY #728
Street 1105 SOUTH POKEGAMA AVENUE
City GRAND RAPIDS
State MN
ZIP 55744
Phone 218 326-9431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/28/2025
Certificate Expiration Date 2/27/2027
Facility Type Pharmacy
Lab Director HANNAH MITTET

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