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24D2284409 CLIA NUMBER - GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #17368

Laboratory Demographics

CLIA Number: 24D2284409

Facility Name: GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #17368

Facility Address:
6445 RICHFIELD PKWY
RICHFIELD, MN
ZIP 55423
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Facility Phone Number: 612 252-0474

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1427242569

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 24D2284409
LAB Type Pharmacy
Facility Name GRAND ST PAUL CVS, LLC DBA CVS/PHARMACY #17368
Street 6445 RICHFIELD PKWY
City RICHFIELD
State MN
ZIP 55423
Phone 612 252-0474
CertificateType 4
CertificateEffectiveDate 6/22/2023
CertificateExpirationDate 6/21/2025
FacilityType Waiver

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