24D1067645 CLIA NUMBER - CUB PHARMACY #1653

Laboratory Demographics

  • CLIA Code: 24D1067645
  • Facility Name: CUB PHARMACY #1653
  • Facility Address: 1200 SOUTH RIVERFRONT DRIVE
    MANKATO, MN
    ZIP 56001
  • Facility Phone: 507 345-5066
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAIRUS HOVEY- MCBRIDE
  • NPI Number: 1396851606
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067645
LAB Type Pharmacy
Facility Name CUB PHARMACY #1653
Street 1200 SOUTH RIVERFRONT DRIVE
City MANKATO
State MN
ZIP 56001
Phone 507 345-5066
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/24/2025
Certificate Expiration Date 4/23/2027
Facility Type Pharmacy
Lab Director JAIRUS HOVEY- MCBRIDE

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