24D2080066 CLIA NUMBER - CUB PHARMACY #1597

Laboratory Demographics

  • CLIA Code: 24D2080066
  • Facility Name: CUB PHARMACY #1597
  • Facility Address: 17756 KENWOOD TRAIL
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 952 898-4505
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NANCY R. SCORE
  • NPI Number: 1184739229
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2080066
LAB Type Pharmacy
Facility Name CUB PHARMACY #1597
Street 17756 KENWOOD TRAIL
City LAKEVILLE
State MN
ZIP 55044
Phone 952 898-4505
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 NANCY R. SCORE

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