24D1067672 CLIA NUMBER - CUB PHARMACY #1633

Laboratory Demographics

  • CLIA Code: 24D1067672
  • Facility Name: CUB PHARMACY #1633
  • Facility Address: 4445 NORTH NATHAN LANE
    PLYMOUTH, MN
    ZIP 55442
  • Facility Phone: 763 557-0377
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HANNAH BORGSTROM
  • NPI Number: 1568577609
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1067672
LAB Type Pharmacy
Facility Name CUB PHARMACY #1633
Street 4445 NORTH NATHAN LANE
City PLYMOUTH
State MN
ZIP 55442
Phone 763 557-0377
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 HANNAH BORGSTROM

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