24D2232294 CLIA NUMBER - WALGREENS #02078

Laboratory Demographics

  • CLIA Code: 24D2232294
  • Facility Name: WALGREENS #02078
  • Facility Address: 2134 BUNKER LAKE BLVD NW
    ANDOVER, MN
    ZIP 55304
  • Facility Phone: 763 754-6409
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AGASSI A. MILA
  • NPI Number: 1013922244
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Pharmacy
Lab Director AGASSI A. MILA

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