24D1067489 CLIA NUMBER - CUB PHARMACY #1923

Laboratory Demographics

  • CLIA Code: 24D1067489
  • Facility Name: CUB PHARMACY #1923
  • Facility Address: 6775 YORK AVENUE SOUTH
    EDINA, MN
    ZIP 55435
  • Facility Phone: 952 925-3911
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TINA SPARKS OVIATT
  • NPI Number: 1750496899
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067489
LAB Type Pharmacy
Facility Name CUB PHARMACY #1923
Street 6775 YORK AVENUE SOUTH
City EDINA
State MN
ZIP 55435
Phone 952 925-3911
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 TINA SPARKS OVIATT

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