24D0721037 CLIA NUMBER - MEDICINE SHOPPE,THE

Laboratory Demographics

  • CLIA Code: 24D0721037
  • Facility Name: MEDICINE SHOPPE,THE
  • Facility Address: 1208 CLOQUET AVE
    CLOQUET, MN
    ZIP 55720
  • Facility Phone: 218 879-4547
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JOHN A. GUSTK
  • NPI Number: 1316053622
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D0721037
LAB Type Pharmacy
Facility Name MEDICINE SHOPPE,THE
Street 1208 CLOQUET AVE
City CLOQUET
State MN
ZIP 55720
Phone 218 879-4547
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type Pharmacy
Lab Director JOHN A. GUSTK

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