24D2153898 CLIA NUMBER - WALMART PHARMACY 10-5976

Laboratory Demographics

  • CLIA Code: 24D2153898
  • Facility Name: WALMART PHARMACY 10-5976
  • Facility Address: 11505 ULYSSES STREET NE
    BLAINE, MN
    ZIP 55434
  • Facility Phone: 763 862-8719
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRYSTAL S. SIEVERT
  • NPI Number: 1205273984
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2153898
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5976
Street 11505 ULYSSES STREET NE
City BLAINE
State MN
ZIP 55434
Phone 763 862-8719
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/31/2024
Certificate Expiration Date 8/30/2026
Facility Type Pharmacy
Lab Director KRYSTAL S. SIEVERT

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