24D2230088 CLIA NUMBER - WALGREENS #11690

Laboratory Demographics

  • CLIA Code: 24D2230088
  • Facility Name: WALGREENS #11690
  • Facility Address: 121 DEPOT DR
    WACONIA, MN
    ZIP 55387
  • Facility Phone: 952 442-2146
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TARA M. KLEINKNIGHT
  • NPI Number: 1194990143
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2230088
LAB Type Pharmacy
Facility Name WALGREENS #11690
Street 121 DEPOT DR
City WACONIA
State MN
ZIP 55387
Phone 952 442-2146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director TARA M. KLEINKNIGHT

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