11D2281435 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS PHARMACY #04531

Laboratory Demographics

  • CLIA Code: 11D2281435
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS PHARMACY #04531
  • Facility Address: 506 EAST 3RD STREET
    JACKSON, GA
    ZIP 30233
  • Facility Phone: 770 775-7134
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENNETH AMAYO
  • NPI Number: 1619070448
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281435
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS PHARMACY #04531
Street 506 EAST 3RD STREET
City JACKSON
State GA
ZIP 30233
Phone 770 775-7134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Pharmacy
Lab Director KENNETH AMAYO

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