24D1067464 CLIA NUMBER - CUB PHARMACY # 1616

Laboratory Demographics

CLIA Number: 24D1067464

Facility Name: CUB PHARMACY # 1616

Facility Address:
1940 CLIFF LAKE ROAD
EAGAN, MN
ZIP 55122
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Facility Phone Number: 651 454-5150

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1689789729

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	24D1067464
LAB Type	Pharmacy
Facility Name	CUB PHARMACY # 1616
Street	1940 CLIFF LAKE ROAD
City	EAGAN
State	MN
ZIP	55122
Phone	651 454-5150
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