11D2282798 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04255

Laboratory Demographics

  • CLIA Code: 11D2282798
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04255
  • Facility Address: 3012 HARTLEY BRIDGE ROAD
    MACON, GA
    ZIP 31216
  • Facility Phone: 478 785-1962
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERNESTINA GONZALEZ
  • NPI Number: 1992808752
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D2282798
LAB Type Pharmacy
Facility Name GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04255
Street 3012 HARTLEY BRIDGE ROAD
City MACON
State GA
ZIP 31216
Phone 478 785-1962
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 ERNESTINA GONZALEZ

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