11D2281264 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05658

Laboratory Demographics

  • CLIA Code: 11D2281264
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05658
  • Facility Address: 2041 NORTH ELM STREET
    COMMERCE, GA
    ZIP 30529
  • Facility Phone: 706 335-5107
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: THOMAS SHATTO
  • NPI Number: 1437252277
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281264
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05658
Street 2041 NORTH ELM STREET
City COMMERCE
State GA
ZIP 30529
Phone 706 335-5107
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 THOMAS SHATTO

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