24D2185878 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1303

Laboratory Demographics

  • CLIA Code: 24D2185878
  • Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1303
  • Facility Address: 10930 UNIVERSITY AVENUE NW
    COON RAPIDS, MN
    ZIP 55448
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IMAD ZALLOUM
  • NPI Number: 1770683112
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2185878
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1303
Street 10930 UNIVERSITY AVENUE NW
City COON RAPIDS
State MN
ZIP 55448
Phone 401 770-6431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/11/2024
Certificate Expiration Date 6/10/2026
Facility Type Pharmacy
Lab Director IMAD ZALLOUM

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