24D1067487 CLIA NUMBER - CUB PHARMACY #1922

Laboratory Demographics

  • CLIA Code: 24D1067487
  • Facility Name: CUB PHARMACY #1922
  • Facility Address: 19216 FREEPORT STREET
    ELK RIVER, MN
    ZIP 55330
  • Facility Phone: 763 241-8112
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COURTNEY RUTER
  • NPI Number: 1932214079
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067487
LAB Type Pharmacy
Facility Name CUB PHARMACY #1922
Street 19216 FREEPORT STREET
City ELK RIVER
State MN
ZIP 55330
Phone 763 241-8112
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 COURTNEY RUTER

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