24D2189091 CLIA NUMBER - MOUNTAIN LAKE PHARMACY LLC DBA PETERSON DRUG AN

Laboratory Demographics

  • CLIA Code: 24D2189091
  • Facility Name: MOUNTAIN LAKE PHARMACY LLC DBA PETERSON DRUG AN
  • Facility Address: 1007 3RD AVENUE
    MOUNTAIN LAKE, MN
    ZIP 56159
  • Facility Phone: (507) 427-2707
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERICA SCHROEDER
  • NPI Number: 1689655243
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2189091
LAB Type Pharmacy
Facility Name MOUNTAIN LAKE PHARMACY LLC DBA PETERSON DRUG AN
Street 1007 3RD AVENUE
City MOUNTAIN LAKE
State MN
ZIP 56159
Phone 5074272707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2024
Certificate Expiration Date 7/26/2026
Facility Type Pharmacy
Lab Director ERICA SCHROEDER

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This page was last updated on: 5/18/2026