24D2153930 CLIA NUMBER - WALMART PHARMACY 10-3404

Laboratory Demographics

  • CLIA Code: 24D2153930
  • Facility Name: WALMART PHARMACY 10-3404
  • Facility Address: 1960 TWIN LAKES PARKWAY
    ROSEVILLE, MN
    ZIP 55113
  • Facility Phone: 612 788-1478
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PHILIP POLE
  • NPI Number: 1700803103
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2153930
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3404
Street 1960 TWIN LAKES PARKWAY
City ROSEVILLE
State MN
ZIP 55113
Phone 612 788-1478
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/4/2024
Certificate Expiration Date 9/3/2026
Facility Type Pharmacy
Lab Director PHILIP POLE

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