24D2230099 CLIA NUMBER - WALGREENS #12404

Laboratory Demographics

  • CLIA Code: 24D2230099
  • Facility Name: WALGREENS #12404
  • Facility Address: 3142 S SERVICE DR
    RED WING, MN
    ZIP 55066
  • Facility Phone: 651 327-5000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GUTATA F. URGESSA
  • NPI Number: 1982839544
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2230099
LAB Type Pharmacy
Facility Name WALGREENS #12404
Street 3142 S SERVICE DR
City RED WING
State MN
ZIP 55066
Phone 651 327-5000
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 GUTATA F. URGESSA

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