24D2242461 CLIA NUMBER - COBORN'S PHARMACY #2047

Laboratory Demographics

  • CLIA Code: 24D2242461
  • Facility Name: COBORN'S PHARMACY #2047
  • Facility Address: 15700 88TH ST NE
    OTSEGO, MN
    ZIP 55330
  • Facility Phone: 763 328-1707
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON D. MILLER
  • NPI Number: 1851464499
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 24D2242461
LAB Type Pharmacy
Facility Name COBORN'S PHARMACY #2047
Street 15700 88TH ST NE
City OTSEGO
State MN
ZIP 55330
Phone 763 328-1707
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Pharmacy
Lab Director JASON D. MILLER

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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