11D2281659 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04719

Laboratory Demographics

CLIA Number: 11D2281659

Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04719

Facility Address:
2080 HOG MOUNTAIN ROAD
WATKINSVILLE, GA
ZIP 30677
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Facility Phone Number: 770 769-8031

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1356444103

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	11D2281659
LAB Type	Pharmacy
Facility Name	GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04719
Street	2080 HOG MOUNTAIN ROAD
City	WATKINSVILLE
State	GA
ZIP	30677
Phone	770 769-8031
CertificateType	4
CertificateEffectiveDate	5/10/2023
CertificateExpirationDate	5/9/2025
FacilityType	Waiver

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