24D1067458 CLIA NUMBER - CUB PHARMACY # 1608

Laboratory Demographics

  • CLIA Code: 24D1067458
  • Facility Name: CUB PHARMACY # 1608
  • Facility Address: 585 NORTHTOWN DRIVE
    BLAINE, MN
    ZIP 55014
  • Facility Phone: 763 780-7350
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIRSTEN DIMATTEO
  • NPI Number: 1225143365
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067458
LAB Type Pharmacy
Facility Name CUB PHARMACY # 1608
Street 585 NORTHTOWN DRIVE
City BLAINE
State MN
ZIP 55014
Phone 763 780-7350
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 KIRSTEN DIMATTEO

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