24D2230090 CLIA NUMBER - WALGREENS #11835

Laboratory Demographics

  • CLIA Code: 24D2230090
  • Facility Name: WALGREENS #11835
  • Facility Address: 7200 CEDAR LAKE RD S
    SAINT LOUIS PARK, MN
    ZIP 55426
  • Facility Phone: 952 252-2502
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYIKA M. BASSAGOUT
  • NPI Number: 1295979763
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2230090
LAB Type Pharmacy
Facility Name WALGREENS #11835
Street 7200 CEDAR LAKE RD S
City SAINT LOUIS PARK
State MN
ZIP 55426
Phone 952 252-2502
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 TYIKA M. BASSAGOUT

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