24D1067484 CLIA NUMBER - CUB PHARMACY # 1629

Laboratory Demographics

  • CLIA Code: 24D1067484
  • Facility Name: CUB PHARMACY # 1629
  • Facility Address: 3930 SILVER LAKE ROAD NE
    SAINT ANTHONY, MN
    ZIP 55421
  • Facility Phone: 612 781-6405
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BREANNE DIETZ
  • NPI Number: 1669587705
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067484
LAB Type Pharmacy
Facility Name CUB PHARMACY # 1629
Street 3930 SILVER LAKE ROAD NE
City SAINT ANTHONY
State MN
ZIP 55421
Phone 612 781-6405
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 BREANNE DIETZ

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