24D2217648 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #16002

Laboratory Demographics

CLIA Number: 24D2217648

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #16002

Facility Address:
2555 W 79TH ST
BLOOMINGTON, MN
ZIP 55431
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376565044

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	24D2217648
LAB Type	Pharmacy
Facility Name	GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #16002
Street	2555 W 79TH ST
City	BLOOMINGTON
State	MN
ZIP	55431
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	3/23/2023
CertificateExpirationDate	3/22/2025
FacilityType	Waiver

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