24D1067650 CLIA NUMBER - CUB PHARMACY #1935

Laboratory Demographics

  • CLIA Code: 24D1067650
  • Facility Name: CUB PHARMACY #1935
  • Facility Address: 2197 OLD HUDSON ROAD
    SAINT PAUL, MN
    ZIP 55119
  • Facility Phone: 651 501-4934
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LOIS SWAYNE
  • NPI Number: 1992810030
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067650
LAB Type Pharmacy
Facility Name CUB PHARMACY #1935
Street 2197 OLD HUDSON ROAD
City SAINT PAUL
State MN
ZIP 55119
Phone 651 501-4934
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 LOIS SWAYNE

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