24D2255999 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #03054

Laboratory Demographics

  • CLIA Code: 24D2255999
  • Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #03054
  • Facility Address: 1175 MADISON AVE
    MANKATO, MN
    ZIP 56001
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA JOHNSON
  • NPI Number: 1770505455
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2255999
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #03054
Street 1175 MADISON AVE
City MANKATO
State MN
ZIP 56001
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2024
Certificate Expiration Date 3/19/2026
Facility Type Pharmacy
Lab Director AMANDA JOHNSON

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