24D2279719 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11046

Laboratory Demographics

  • CLIA Code: 24D2279719
  • Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11046
  • Facility Address: 17435 COUNTY ROAD 6
    PLYMOUTH, MN
    ZIP 55447
  • Facility Phone: 763 473-0977
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GREGORY MARN
  • NPI Number: 1437620903
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2279719
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #11046
Street 17435 COUNTY ROAD 6
City PLYMOUTH
State MN
ZIP 55447
Phone 763 473-0977
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director GREGORY MARN

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