24D2279716 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11070

Laboratory Demographics

CLIA Number: 24D2279716

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11070

Facility Address:
4400 OAK GROVE PARKWAY
BROOKLYN PARK, MN
ZIP 55443
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Facility Phone Number: 763 315-1935

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1487131330

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	24D2279716
LAB Type	Pharmacy
Facility Name	GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11070
Street	4400 OAK GROVE PARKWAY
City	BROOKLYN PARK
State	MN
ZIP	55443
Phone	763 315-1935
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