10D2284524 CLIA NUMBER - HOLIDAY CVS LLC DBA CVS/PHARMACY #5589

Laboratory Demographics

  • CLIA Code: 10D2284524
  • Facility Name: HOLIDAY CVS LLC DBA CVS/PHARMACY #5589
  • Facility Address: 46 EAST WATSON RD
    ST AUGUSTINE, FL
    ZIP 32086
  • Facility Phone: 904 797-6774
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHARLES MANKRIOUS
  • NPI Number: 1073790879
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 10D2284524
LAB Type Physician Office
Facility Name HOLIDAY CVS LLC DBA CVS/PHARMACY #5589
Street 46 EAST WATSON RD
City ST AUGUSTINE
State FL
ZIP 32086
Phone 904 797-6774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/23/2025
Certificate Expiration Date 6/22/2027
Facility Type Physician Office
Lab Director CHARLES MANKRIOUS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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