24D2221183 CLIA NUMBER - WALGREENS #04038

Laboratory Demographics

  • CLIA Code: 24D2221183
  • Facility Name: WALGREENS #04038
  • Facility Address: 15034 SHANNON PKWY
    ROSEMOUNT, MN
    ZIP 55068
  • Facility Phone: 651 322-6603
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NEVIL F. GENJANG
  • NPI Number: 1578578894
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2221183
LAB Type Pharmacy
Facility Name WALGREENS #04038
Street 15034 SHANNON PKWY
City ROSEMOUNT
State MN
ZIP 55068
Phone 651 322-6603
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2025
Certificate Expiration Date 4/19/2027
Facility Type Pharmacy
Lab Director NEVIL F. GENJANG

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