24D2080035 CLIA NUMBER - CUB PHARMACY #1957

Laboratory Demographics

  • CLIA Code: 24D2080035
  • Facility Name: CUB PHARMACY #1957
  • Facility Address: 10200 SIXTH AVENUE NORTH
    PLYMOUTH, MN
    ZIP 55441
  • Facility Phone: 763 546-2311
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DYLAN HALL
  • NPI Number: 1316358955
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2080035
LAB Type Pharmacy
Facility Name CUB PHARMACY #1957
Street 10200 SIXTH AVENUE NORTH
City PLYMOUTH
State MN
ZIP 55441
Phone 763 546-2311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/30/2024
Certificate Expiration Date 6/29/2026
Facility Type Pharmacy
Lab Director DYLAN HALL

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