24D2185890 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #4696

Laboratory Demographics

  • CLIA Code: 24D2185890
  • Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #4696
  • Facility Address: 21455 JOHN MILLESS DRIVE
    ROGERS, MN
    ZIP 55374
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICOLE LARSON
  • NPI Number: 1952323644
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2185890
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #4696
Street 21455 JOHN MILLESS DRIVE
City ROGERS
State MN
ZIP 55374
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 NICOLE LARSON

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