11D0963277 CLIA NUMBER - CITY DRUG STORE

Laboratory Demographics

  • CLIA Code: 11D0963277
  • Facility Name: CITY DRUG STORE
  • Facility Address: 1704 MEADOWS LANE
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 537-4147
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BENJAMIN R. BLACK
  • NPI Number: 1881650612
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0963277
LAB Type Pharmacy
Facility Name CITY DRUG STORE
Street 1704 MEADOWS LANE
City VIDALIA
State GA
ZIP 30474
Phone 912 537-4147
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/27/2025
Certificate Expiration Date 7/26/2027
Facility Type Pharmacy
Lab Director BENJAMIN R. BLACK

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