24D1067659 CLIA NUMBER - CUB PHARMACY #1643

Laboratory Demographics

  • CLIA Code: 24D1067659
  • Facility Name: CUB PHARMACY #1643
  • Facility Address: 8600 114TH AVENUE NORTH
    CHAMPLIN, MN
    ZIP 55316
  • Facility Phone: 763 422-8700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREA NEWBAUER
  • NPI Number: 1710092853
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067659
LAB Type Pharmacy
Facility Name CUB PHARMACY #1643
Street 8600 114TH AVENUE NORTH
City CHAMPLIN
State MN
ZIP 55316
Phone 763 422-8700
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 ANDREA NEWBAUER

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