24D1067466 CLIA NUMBER - CUB PHARMACY #1914

Laboratory Demographics

  • CLIA Code: 24D1067466
  • Facility Name: CUB PHARMACY #1914
  • Facility Address: 12900 RIVERDALE DRIVE
    COON RAPIDS, MN
    ZIP 55448
  • Facility Phone: 763 421-0065
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL JEWELL
  • NPI Number: 1306951447
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067466
LAB Type Pharmacy
Facility Name CUB PHARMACY #1914
Street 12900 RIVERDALE DRIVE
City COON RAPIDS
State MN
ZIP 55448
Phone 763 421-0065
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 MICHAEL JEWELL

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