10D2187068 CLIA NUMBER - HOLIDAY CVS LLC DBA CVSPHARMACY #5410

Laboratory Demographics

  • CLIA Code: 10D2187068
  • Facility Name: HOLIDAY CVS LLC DBA CVSPHARMACY #5410
  • Facility Address: 4478 TAMIAMI TRAIL
    PORT CHARLOTTE, FL
    ZIP 33980
  • Facility Phone: 941 235-1120
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHLEEN SUTHERLAND
  • NPI Number: 1639407596
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D2187068
LAB Type Pharmacy
Facility Name HOLIDAY CVS LLC DBA CVSPHARMACY #5410
Street 4478 TAMIAMI TRAIL
City PORT CHARLOTTE
State FL
ZIP 33980
Phone 941 235-1120
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Pharmacy
Lab Director KATHLEEN SUTHERLAND

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