24D1067452 CLIA NUMBER - CUB PHARMACY #1611

Laboratory Demographics

  • CLIA Code: 24D1067452
  • Facility Name: CUB PHARMACY #1611
  • Facility Address: 100 WEST MAPLE ROAD B
    MAPLEWOOD, MN
    ZIP 55117
  • Facility Phone: 651 489-6271
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NASTEHA MOALIN
  • NPI Number: 1407961543
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067452
LAB Type Pharmacy
Facility Name CUB PHARMACY #1611
Street 100 WEST MAPLE ROAD B
City MAPLEWOOD
State MN
ZIP 55117
Phone 651 489-6271
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/19/2025
Certificate Expiration Date 4/18/2027
Facility Type Pharmacy
Lab Director NASTEHA MOALIN

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