24D2279699 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #10397

Laboratory Demographics

CLIA Number: 24D2279699

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #10397

Facility Address:
25 2ND STREET NORTHEAST
AITKIN, MN
ZIP 56431
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Facility Phone Number: 218 927-3754

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1598101362

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	24D2279699
LAB Type	Pharmacy
Facility Name	GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #10397
Street	25 2ND STREET NORTHEAST
City	AITKIN
State	MN
ZIP	56431
Phone	218 927-3754
CertificateType	4
CertificateEffectiveDate	4/6/2023
CertificateExpirationDate	4/5/2025
FacilityType	Waiver

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