24D1056325 CLIA NUMBER - CUB PHARMACY #1632

Laboratory Demographics

  • CLIA Code: 24D1056325
  • Facility Name: CUB PHARMACY #1632
  • Facility Address: 216 - 7TH STREET WEST
    MONTICELLO, MN
    ZIP 55362
  • Facility Phone: 763 295-6159
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRETT BERTELSON
  • NPI Number: 1104931245
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1056325
LAB Type Pharmacy
Facility Name CUB PHARMACY #1632
Street 216 - 7TH STREET WEST
City MONTICELLO
State MN
ZIP 55362
Phone 763 295-6159
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/13/2024
Certificate Expiration Date 7/12/2026
Facility Type Pharmacy
Lab Director BRETT BERTELSON

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