24D1026912 CLIA NUMBER - CUB PHARMACY #1634

Laboratory Demographics

  • CLIA Code: 24D1026912
  • Facility Name: CUB PHARMACY #1634
  • Facility Address: 2013 BROADWAY AVENUE W
    FOREST LAKE, MN
    ZIP 55025
  • Facility Phone: 651 982-4603
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MADISON CAMPBELL
  • NPI Number: 1558476697
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1026912
LAB Type Pharmacy
Facility Name CUB PHARMACY #1634
Street 2013 BROADWAY AVENUE W
City FOREST LAKE
State MN
ZIP 55025
Phone 651 982-4603
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/17/2024
Certificate Expiration Date 6/16/2026
Facility Type Pharmacy
Lab Director MADISON CAMPBELL

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