24D2097908 CLIA NUMBER - WALMART PHARMACY 10-2274

Laboratory Demographics

  • CLIA Code: 24D2097908
  • Facility Name: WALMART PHARMACY 10-2274
  • Facility Address: 200 12TH STREET SW
    FOREST LAKE, MN
    ZIP 55025
  • Facility Phone: 651 464-9742
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL GRUETZMAN
  • NPI Number: 1801813290
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2097908
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2274
Street 200 12TH STREET SW
City FOREST LAKE
State MN
ZIP 55025
Phone 651 464-9742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Pharmacy
Lab Director DANIEL GRUETZMAN

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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