24D1089059 CLIA NUMBER - CUB PHARMACY #1657

Laboratory Demographics

  • CLIA Code: 24D1089059
  • Facility Name: CUB PHARMACY #1657
  • Facility Address: 20250 HERITAGE DRIVE
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 952 469-8404
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA VANDERMAUSE
  • NPI Number: 1265628515
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D1089059
LAB Type Pharmacy
Facility Name CUB PHARMACY #1657
Street 20250 HERITAGE DRIVE
City LAKEVILLE
State MN
ZIP 55044
Phone 952 469-8404
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/10/2024
Certificate Expiration Date 9/9/2026
Facility Type Pharmacy
Lab Director MELISSA VANDERMAUSE

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