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24D2185882 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1784

Laboratory Demographics

CLIA Number: 24D2185882

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1784

Facility Address:
17578 DODD BOULEVARD
LAKEVILLE, MN
ZIP 55044
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1861414559

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 24D2185882
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #1784
Street 17578 DODD BOULEVARD
City LAKEVILLE
State MN
ZIP 55044
Phone 401 770-6431
CertificateType 4
CertificateEffectiveDate 6/11/2022
CertificateExpirationDate 6/10/2024
FacilityType Waiver

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This page was last updated on: 4/23/2024