24D1067490 CLIA NUMBER - CUB PHARMACY #1924

Laboratory Demographics

  • CLIA Code: 24D1067490
  • Facility Name: CUB PHARMACY #1924
  • Facility Address: 3620 TEXAS AVENUE SOUTH
    SAINT LOUIS PARK, MN
    ZIP 55426
  • Facility Phone: (952) 933-3177
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEN RISS
  • NPI Number: 1740395888
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067490
LAB Type Pharmacy
Facility Name CUB PHARMACY #1924
Street 3620 TEXAS AVENUE SOUTH
City SAINT LOUIS PARK
State MN
ZIP 55426
Phone 9529333177
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 JEN RISS

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This page was last updated on: 5/18/2026