24D2097721 CLIA NUMBER - WALMART PHARMACY 10-1786

Laboratory Demographics

  • CLIA Code: 24D2097721
  • Facility Name: WALMART PHARMACY 10-1786
  • Facility Address: 1360 TOWN CENTRE DRIVE
    EAGAN, MN
    ZIP 55123
  • Facility Phone: 651 686-7431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRETA EBELING
  • NPI Number: 1619994084
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2097721
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1786
Street 1360 TOWN CENTRE DRIVE
City EAGAN
State MN
ZIP 55123
Phone 651 686-7431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2025
Certificate Expiration Date 6/22/2027
Facility Type Pharmacy
Lab Director BRETA EBELING

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