24D1067471 CLIA NUMBER - CUB PHARMACY #1917

Laboratory Demographics

  • CLIA Code: 24D1067471
  • Facility Name: CUB PHARMACY #1917
  • Facility Address: 8015 DEN ROAD
    EDEN PRAIRIE, MN
    ZIP 55344
  • Facility Phone: 952 941-6728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARIAM KHALIL
  • NPI Number: 1851406995
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067471
LAB Type Pharmacy
Facility Name CUB PHARMACY #1917
Street 8015 DEN ROAD
City EDEN PRAIRIE
State MN
ZIP 55344
Phone 952 941-6728
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 MARIAM KHALIL

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