11D2255879 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04589

Laboratory Demographics

  • CLIA Code: 11D2255879
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04589
  • Facility Address: 869 HORIZON SOUTH PARKWAY
    GROVETOWN, GA
    ZIP 30813
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAINASHIA PHILLIPS
  • NPI Number: 1477656247
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2255879
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04589
Street 869 HORIZON SOUTH PARKWAY
City GROVETOWN
State GA
ZIP 30813
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 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Pharmacy
Lab Director TAINASHIA PHILLIPS

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