24D2321649 CLIA NUMBER - SUPERVALU PHARMACIES INC. D/B/A CUB PHARMACY #1966

Laboratory Demographics

  • CLIA Code: 24D2321649
  • Facility Name: SUPERVALU PHARMACIES INC. D/B/A CUB PHARMACY #1966
  • Facility Address: 1750 COUNTY ROAD 42 WEST
    BURNSVILLE, MN
    ZIP 55337
  • Facility Phone: 952 800-0988
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: ROBERT L. HAGIE
  • NPI Number: 1093517914
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 24D2321649
LAB Type Physician Office
Facility Name SUPERVALU PHARMACIES INC. D/B/A CUB PHARMACY #1966
Street 1750 COUNTY ROAD 42 WEST
City BURNSVILLE
State MN
ZIP 55337
Phone 952 800-0988
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Physician Office
Lab Director ROBERT L. HAGIE

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