11D2256766 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04567

Laboratory Demographics

CLIA Number: 11D2256766

Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04567

Facility Address:
5421 NEW JESUP HIGHWAY
BRUNSWICK, GA
ZIP 31523
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1851494512

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	11D2256766
LAB Type	Pharmacy
Facility Name	GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04567
Street	5421 NEW JESUP HIGHWAY
City	BRUNSWICK
State	GA
ZIP	31523
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	3/28/2024
CertificateExpirationDate	3/27/2026
FacilityType	Waiver

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