24D1067499 CLIA NUMBER - CUB PHARMACY #1638

Laboratory Demographics

  • CLIA Code: 24D1067499
  • Facility Name: CUB PHARMACY #1638
  • Facility Address: 2050 NORTHDALE BOULEVARD NW SUITE 1
    COON RAPIDS, MN
    ZIP 55433
  • Facility Phone: 763 754-9036
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA HANSEN
  • NPI Number: 1902911043
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067499
LAB Type Pharmacy
Facility Name CUB PHARMACY #1638
Street 2050 NORTHDALE BOULEVARD NW SUITE 1
City COON RAPIDS
State MN
ZIP 55433
Phone 763 754-9036
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 AMANDA HANSEN

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