24D2215351 CLIA NUMBER - WALGREENS #06714

Laboratory Demographics

  • CLIA Code: 24D2215351
  • Facility Name: WALGREENS #06714
  • Facility Address: 2860 COON RAPIDS BLVD NW
    COON RAPIDS, MN
    ZIP 55433
  • Facility Phone: 763 421-1784
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JITKA X. SIRUCEK
  • NPI Number: 1942215256
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2215351
LAB Type Pharmacy
Facility Name WALGREENS #06714
Street 2860 COON RAPIDS BLVD NW
City COON RAPIDS
State MN
ZIP 55433
Phone 763 421-1784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/3/2025
Certificate Expiration Date 3/2/2027
Facility Type Pharmacy
Lab Director JITKA X. SIRUCEK

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