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24D2232294 CLIA NUMBER - WALGREENS #02078

Laboratory Demographics

CLIA Number: 24D2232294

Facility Name: WALGREENS #02078

Facility Address:
2134 BUNKER LAKE BLVD NW
ANDOVER, MN
ZIP 55304
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Facility Phone Number: 763 754-6409

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1013922244

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 24D2232294
LAB Type Pharmacy
Facility Name WALGREENS #02078
Street 2134 BUNKER LAKE BLVD NW
City ANDOVER
State MN
ZIP 55304
Phone 763 754-6409
CertificateType 4
CertificateEffectiveDate 8/12/2023
CertificateExpirationDate 8/11/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024