24D1067494 CLIA NUMBER - CUB PHARMACY #1652

Laboratory Demographics

  • CLIA Code: 24D1067494
  • Facility Name: CUB PHARMACY #1652
  • Facility Address: 405 PHESANT RIDGE DRIVE
    BLAINE, MN
    ZIP 55449
  • Facility Phone: 763 784-0334
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK NEWMAN
  • NPI Number: 1649385782
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067494
LAB Type Pharmacy
Facility Name CUB PHARMACY #1652
Street 405 PHESANT RIDGE DRIVE
City BLAINE
State MN
ZIP 55449
Phone 763 784-0334
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 MARK NEWMAN

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