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24D2217974 CLIA NUMBER - WALGREENS #05080

Laboratory Demographics

CLIA Number: 24D2217974

Facility Name: WALGREENS #05080

Facility Address:
10180 HENNEPIN TOWN RD
EDEN PRAIRIE, MN
ZIP 55347
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Facility Phone Number: 952 941-8666

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1851306088

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 24D2217974
LAB Type Pharmacy
Facility Name WALGREENS #05080
Street 10180 HENNEPIN TOWN RD
City EDEN PRAIRIE
State MN
ZIP 55347
Phone 952 941-8666
CertificateType 4
CertificateEffectiveDate 3/25/2023
CertificateExpirationDate 3/24/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024