11D2219866 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05640

Laboratory Demographics

  • Code: 11D2219866
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05640
  • Facility Address: 6327 HIGHWAY 53 EAST
    DAWSONVILLE, GA
    ZIP 30534
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • NPI Number: 1700989555
  • Taxonomy: 333600000X - Pharmacy
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CLIA Record

Field Name Field Value
CLIA Number 11D2219866
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05640
Street 6327 HIGHWAY 53 EAST
City DAWSONVILLE
State GA
ZIP 30534
Phone 401 770-6431
Certificate Type 4
Certificate Effective Date 4/8/2023
Certificate Expiration Date 4/7/2025
Facility Type Waiver

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This page was last updated on: 4/23/2024