24D1067671 CLIA NUMBER - CUB PHARMACY #1930

Laboratory Demographics

  • CLIA Code: 24D1067671
  • Facility Name: CUB PHARMACY #1930
  • Facility Address: 14133 EDGEWOOD DRIVE NORTH
    BAXTER, MN
    ZIP 56425
  • Facility Phone: 218 855-0880
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANNA WENZEL
  • NPI Number: 1659486793
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067671
LAB Type Pharmacy
Facility Name CUB PHARMACY #1930
Street 14133 EDGEWOOD DRIVE NORTH
City BAXTER
State MN
ZIP 56425
Phone 218 855-0880
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 ANNA WENZEL

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