24D1067478 CLIA NUMBER - CUB PHARMACY #1601

Laboratory Demographics

  • CLIA Code: 24D1067478
  • Facility Name: CUB PHARMACY #1601
  • Facility Address: 5301 36TH AVE NORTH
    CRYSTAL, MN
    ZIP 55422
  • Facility Phone: 763 287-9797
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LORI TSHOSA
  • NPI Number: 1396850434
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067478
LAB Type Pharmacy
Facility Name CUB PHARMACY #1601
Street 5301 36TH AVE NORTH
City CRYSTAL
State MN
ZIP 55422
Phone 763 287-9797
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 LORI TSHOSA

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