11D2255739 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04404

Laboratory Demographics

  • CLIA Code: 11D2255739
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04404
  • Facility Address: 736 S HILL STREET
    GRIFFIN, GA
    ZIP 30224
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STANLEY OGWOTU
  • NPI Number: 1366545121
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2255739
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04404
Street 736 S HILL STREET
City GRIFFIN
State GA
ZIP 30224
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 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Pharmacy
Lab Director STANLEY OGWOTU

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