24D1067469 CLIA NUMBER - CUB PHARMACY #1604

Laboratory Demographics

  • CLIA Code: 24D1067469
  • Facility Name: CUB PHARMACY #1604
  • Facility Address: 15350 CEDAR AVENUE
    APPLE VALLEY, MN
    ZIP 55124
  • Facility Phone: 952 431-2221
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICK ROOT
  • NPI Number: 1033224175
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067469
LAB Type Pharmacy
Facility Name CUB PHARMACY #1604
Street 15350 CEDAR AVENUE
City APPLE VALLEY
State MN
ZIP 55124
Phone 952 431-2221
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 NICK ROOT

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