24D2107535 CLIA NUMBER - CUB PHARMACY #1591

Laboratory Demographics

  • CLIA Code: 24D2107535
  • Facility Name: CUB PHARMACY #1591
  • Facility Address: 1920 BUERKLE ROAD
    WHITE BEAR LAKE, MN
    ZIP 55110
  • Facility Phone: 651 777-2350
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JADE THEISEN
  • NPI Number: 1851761514
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2107535
LAB Type Pharmacy
Facility Name CUB PHARMACY #1591
Street 1920 BUERKLE ROAD
City WHITE BEAR LAKE
State MN
ZIP 55110
Phone 651 777-2350
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2024
Certificate Expiration Date 1/14/2026
Facility Type Pharmacy
Lab Director JADE THEISEN

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