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24D1067454 CLIA NUMBER - CUB PHARMACY #1612

Laboratory Demographics

CLIA Number: 24D1067454

Facility Name: CUB PHARMACY #1612

Facility Address:
1801 MARKET DRIVE
STILLWATER, MN
ZIP 55082
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Facility Phone Number: 651 430-2362

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1598870636

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 24D1067454
LAB Type Pharmacy
Facility Name CUB PHARMACY #1612
Street 1801 MARKET DRIVE
City STILLWATER
State MN
ZIP 55082
Phone 651 430-2362
CertificateType 4
CertificateEffectiveDate 4/19/2023
CertificateExpirationDate 4/18/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024