11D2281263 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05628

Laboratory Demographics

  • CLIA Code: 11D2281263
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05628
  • Facility Address: 5415 N HENRY BOULEVARD
    STOCKBRIDGE, GA
    ZIP 30281
  • Facility Phone: 770 474-1355
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CONRAD WYNTER
  • NPI Number: 1356444194
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281263
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05628
Street 5415 N HENRY BOULEVARD
City STOCKBRIDGE
State GA
ZIP 30281
Phone 770 474-1355
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/4/2025
Certificate Expiration Date 5/3/2027
Facility Type Pharmacy
Lab Director CONRAD WYNTER

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