11D2282022 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #03082

Laboratory Demographics

  • CLIA Code: 11D2282022
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #03082
  • Facility Address: 1597 HOGANSVILLE ROAD
    LAGRANGE, GA
    ZIP 30241
  • Facility Phone: 912 352-0303
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FREUSTZA MILLIEN
  • NPI Number: 1124121876
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2282022
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #03082
Street 1597 HOGANSVILLE ROAD
City LAGRANGE
State GA
ZIP 30241
Phone 912 352-0303
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 FREUSTZA MILLIEN

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