24D2096191 CLIA NUMBER - CUB PHARMACY #1962

Laboratory Demographics

  • CLIA Code: 24D2096191
  • Facility Name: CUB PHARMACY #1962
  • Facility Address: 2612 SOUTH BROADWAY ST
    ALEXANDRIA, MN
    ZIP 56308
  • Facility Phone: 320 759-1135
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALISSA LARSON
  • NPI Number: 1841685591
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2096191
LAB Type Pharmacy
Facility Name CUB PHARMACY #1962
Street 2612 SOUTH BROADWAY ST
City ALEXANDRIA
State MN
ZIP 56308
Phone 320 759-1135
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director ALISSA LARSON

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