11D2282790 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04668

Laboratory Demographics

  • CLIA Code: 11D2282790
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04668
  • Facility Address: 2091 LOST MOUNTAIN RD
    POWDER SPRINGS, GA
    ZIP 30127
  • Facility Phone: 770 943-4136
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VINCENT WILCOX
  • NPI Number: 1053414888
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2282790
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04668
Street 2091 LOST MOUNTAIN RD
City POWDER SPRINGS
State GA
ZIP 30127
Phone 770 943-4136
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Pharmacy
Lab Director VINCENT WILCOX

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