11D2281833 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04582

Laboratory Demographics

CLIA Number: 11D2281833

Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04582

Facility Address:
9849 ROME BOULEVARD
SUMMERVILLE, GA
ZIP 30747
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Facility Phone Number: 706 857-4342

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306949060

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	11D2281833
LAB Type	Pharmacy
Facility Name	GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04582
Street	9849 ROME BOULEVARD
City	SUMMERVILLE
State	GA
ZIP	30747
Phone	706 857-4342
CertificateType	4
CertificateEffectiveDate	5/12/2023
CertificateExpirationDate	5/11/2025
FacilityType	Waiver

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