07D2219020 CLIA NUMBER - CONNECTICUT CVS PHARMACY, LLC DBA- CVS PHARMACY # 02056

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Laboratory Demographics

CLIA Number: 07D2219020

Facility Name: CONNECTICUT CVS PHARMACY, LLC DBA- CVS PHARMACY # 02056

Facility Address:
25 BROADWAY
MYSTIC, CT
ZIP 06355
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1801990726

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	07D2219020
LAB Type	Pharmacy
Facility Name	CONNECTICUT CVS PHARMACY, LLC DBA- CVS PHARMACY # 02056
Street	25 BROADWAY
City	MYSTIC
State	CT
ZIP	06355
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	4/1/2023
CertificateExpirationDate	3/31/2025
FacilityType	Waiver

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