24D2228391 CLIA NUMBER - WALGREENS #07728

Laboratory Demographics

  • CLIA Code: 24D2228391
  • Facility Name: WALGREENS #07728
  • Facility Address: 17630 KENWOOD TRL
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 952 892-5959
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHAD D. KOSTECKA
  • NPI Number: 1841206489
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2228391
LAB Type Pharmacy
Facility Name WALGREENS #07728
Street 17630 KENWOOD TRL
City LAKEVILLE
State MN
ZIP 55044
Phone 952 892-5959
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2023
Certificate Expiration Date 6/24/2025
Facility Type Pharmacy
Lab Director CHAD D. KOSTECKA

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This page was last updated on: 3/20/2025