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24D1067466 CLIA NUMBER - CUB PHARMACY #1914

Laboratory Demographics

CLIA Number: 24D1067466

Facility Name: CUB PHARMACY #1914

Facility Address:
12900 RIVERDALE DRIVE
COON RAPIDS, MN
ZIP 55448
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Facility Phone Number: 763 421-0065

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1306951447

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