24D2214786 CLIA NUMBER - WALGREENS #11764

Laboratory Demographics

  • CLIA Code: 24D2214786
  • Facility Name: WALGREENS #11764
  • Facility Address: 790 N PLAZA DRIVE
    MENDOTA HEIGHTS, MN
    ZIP 55120
  • Facility Phone: 651 414-3787
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRITTANY M. BERGSTEDT
  • NPI Number: 1306140249
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2214786
LAB Type Pharmacy
Facility Name WALGREENS #11764
Street 790 N PLAZA DRIVE
City MENDOTA HEIGHTS
State MN
ZIP 55120
Phone 651 414-3787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/25/2025
Certificate Expiration Date 2/24/2027
Facility Type Pharmacy
Lab Director BRITTANY M. BERGSTEDT

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