11D2255874 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04661

Laboratory Demographics

  • CLIA Code: 11D2255874
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04661
  • Facility Address: 2555 BOLTON ROAD NW
    ATLANTA, GA
    ZIP 30318
  • Facility Phone: (866) 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MAUREEN K. OMESUH
  • NPI Number: 1326141151
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2255874
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04661
Street 2555 BOLTON ROAD NW
City ATLANTA
State GA
ZIP 30318
Phone 8663892727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2026
Certificate Expiration Date 3/17/2028
Facility Type Pharmacy
Lab Director MAUREEN K. OMESUH

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This page was last updated on: 5/18/2026