24D2291065 CLIA NUMBER - WALGREENS 02142

Laboratory Demographics

  • CLIA Code: 24D2291065
  • Facility Name: WALGREENS 02142
  • Facility Address: 734 GRAND AVE
    SAINT PAUL, MN
    ZIP 55105
  • Facility Phone: 651 227-5422
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NEGASH K. BETHELHEM
  • NPI Number: 1689689903
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2291065
LAB Type Pharmacy
Facility Name WALGREENS 02142
Street 734 GRAND AVE
City SAINT PAUL
State MN
ZIP 55105
Phone 651 227-5422
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/4/2025
Certificate Expiration Date 10/3/2027
Facility Type Pharmacy
Lab Director NEGASH K. BETHELHEM

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