11D2282590 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05633

Laboratory Demographics

  • CLIA Code: 11D2282590
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05633
  • Facility Address: 80 FAIRVIEW ROAD
    ELLENWOOD, GA
    ZIP 30294
  • Facility Phone: 770 474-7926
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRUPA PATEL
  • NPI Number: 1619070463
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2282590
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #05633
Street 80 FAIRVIEW ROAD
City ELLENWOOD
State GA
ZIP 30294
Phone 770 474-7926
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/23/2025
Certificate Expiration Date 5/22/2027
Facility Type Pharmacy
Lab Director KRUPA PATEL

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