24D2292059 CLIA NUMBER - WALGREENS 01303

Laboratory Demographics

  • CLIA Code: 24D2292059
  • Facility Name: WALGREENS 01303
  • Facility Address: 4323 CHICAGO AVE
    MINNEAPOLIS, MN
    ZIP 55407
  • Facility Phone: 612 822-9712
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SUPATPORN U. KOTECHOMPOO
  • NPI Number: 1497760706
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2292059
LAB Type Pharmacy
Facility Name WALGREENS 01303
Street 4323 CHICAGO AVE
City MINNEAPOLIS
State MN
ZIP 55407
Phone 612 822-9712
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Pharmacy
Lab Director SUPATPORN U. KOTECHOMPOO

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