11D2281977 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04765

Laboratory Demographics

  • CLIA Code: 11D2281977
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04765
  • Facility Address: 4080 BLOOMFIELD ROAD
    MACON, GA
    ZIP 31206
  • Facility Phone: 478 781-4018
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONIO NOEISAINT
  • NPI Number: 1730282591
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2281977
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04765
Street 4080 BLOOMFIELD ROAD
City MACON
State GA
ZIP 31206
Phone 478 781-4018
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/16/2025
Certificate Expiration Date 5/15/2027
Facility Type Pharmacy
Lab Director ANTHONIO NOEISAINT

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