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11D2223489 CLIA NUMBER - GEORGIA CVS PHARMACY,LLC DBA CVS/PHARMACY #02367

Laboratory Demographics

CLIA Number: 11D2223489

Facility Name: GEORGIA CVS PHARMACY,LLC DBA CVS/PHARMACY #02367

Facility Address:
225 WEST PONCE DELEON AVENUE
DECATUR, GA
ZIP 30030
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1992809826

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name Field Value
CLIA Number 11D2223489
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY,LLC DBA CVS/PHARMACY #02367
Street 225 WEST PONCE DELEON AVENUE
City DECATUR
State GA
ZIP 30030
Phone 866 389-2727
CertificateType 4
CertificateEffectiveDate 5/7/2023
CertificateExpirationDate 5/6/2025
FacilityType Waiver

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