11D2219565 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04504

Laboratory Demographics

  • CLIA Code: 11D2219565
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04504
  • Facility Address: 6330 ROSWELL ROAD
    SANDY SPRINGS, GA
    ZIP 30328
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEXIS AUTERA
  • NPI Number: 1023111770
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2219565
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04504
Street 6330 ROSWELL ROAD
City SANDY SPRINGS
State GA
ZIP 30328
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 ALEXIS AUTERA

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