11D2219871 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #02178

Laboratory Demographics

  • CLIA Code: 11D2219871
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #02178
  • Facility Address: 12070 CRABAPPLE ROAD
    ROSWELL, GA
    ZIP 30075
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHA REDDY THADISINA
  • NPI Number: 1083636633
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2219871
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #02178
Street 12070 CRABAPPLE ROAD
City ROSWELL
State GA
ZIP 30075
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 4/8/2025
Certificate Expiration Date 4/7/2027
Facility Type Pharmacy
Lab Director ASHA REDDY THADISINA

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