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

Laboratory Demographics

  • CLIA Code: 11D2223489
  • Facility Name: GEORGIA CVS PHARMACY,LLC DBA CVS/PHARMACY #02367
  • Facility Address: 225 WEST PONCE DELEON AVENUE
    DECATUR, GA
    ZIP 30030
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SOMMER BOLES-MUCKLE
  • NPI Number: 1992809826
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/7/2025
Certificate Expiration Date 5/6/2027
Facility Type Pharmacy
Lab Director SOMMER BOLES-MUCKLE

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