24D2055063 CLIA NUMBER - WALGREENS #7111

Laboratory Demographics

  • CLIA Code: 24D2055063
  • Facility Name: WALGREENS #7111
  • Facility Address: 1207 WEST BROADWAY AVENUE
    FOREST LAKE, MN
    ZIP 55025
  • Facility Phone: 651 255-1887
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCOTT M. WOOD
  • NPI Number: 1114932340
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2055063
LAB Type Pharmacy
Facility Name WALGREENS #7111
Street 1207 WEST BROADWAY AVENUE
City FOREST LAKE
State MN
ZIP 55025
Phone 651 255-1887
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/21/2023
Certificate Expiration Date 11/20/2025
Facility Type Pharmacy
Lab Director SCOTT M. WOOD

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