11D2219421 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04618

Laboratory Demographics

  • CLIA Code: 11D2219421
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04618
  • Facility Address: 4860 STONE MOUNTAIN HIGHWAY
    LILBURN, GA
    ZIP 30047
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MUKUND UDAVADIA
  • NPI Number: 1871696336
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2219421
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04618
Street 4860 STONE MOUNTAIN HIGHWAY
City LILBURN
State GA
ZIP 30047
Phone 401 770-6431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director MUKUND UDAVADIA

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