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24D2279663 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05616

Laboratory Demographics

CLIA Number: 24D2279663

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05616

Facility Address:
329 FRAZEE STREET EAST
DETROIT LAKES, MN
ZIP 56501
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Facility Phone Number: 218 847-1484

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1356619415

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 24D2279663
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #05616
Street 329 FRAZEE STREET EAST
City DETROIT LAKES
State MN
ZIP 56501
Phone 218 847-1484
CertificateType 4
CertificateEffectiveDate 4/5/2023
CertificateExpirationDate 4/4/2025
FacilityType Waiver

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