24D1067470 CLIA NUMBER - CUB PHARMACY #1916

Laboratory Demographics

  • CLIA Code: 24D1067470
  • Facility Name: CUB PHARMACY #1916
  • Facility Address: 4801 HIGHWAY 101
    MINNETONKA, MN
    ZIP 55345
  • Facility Phone: 952 935-1053
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRETT MOLDENHAUER
  • NPI Number: 1942315080
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067470
LAB Type Pharmacy
Facility Name CUB PHARMACY #1916
Street 4801 HIGHWAY 101
City MINNETONKA
State MN
ZIP 55345
Phone 952 935-1053
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 BRETT MOLDENHAUER

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