24D2279659 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05308

Laboratory Demographics

  • CLIA Code: 24D2279659
  • Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05308
  • Facility Address: 17665 KENWOOD TR
    LAKEVILLE, MN
    ZIP 55044
  • Facility Phone: 952 435-3784
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SARAH MADDOX
  • NPI Number: 1619147923
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2279659
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05308
Street 17665 KENWOOD TR
City LAKEVILLE
State MN
ZIP 55044
Phone 952 435-3784
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/5/2025
Certificate Expiration Date 4/4/2027
Facility Type Pharmacy
Lab Director SARAH MADDOX

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