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

Laboratory Demographics

CLIA Number: 11D2282798

Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #04255

Facility Address:
3012 HARTLEY BRIDGE ROAD
MACON, GA
ZIP 31216
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Facility Phone Number: 478 785-1962

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1992808752

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

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
CertificateType 4
CertificateEffectiveDate 5/25/2023
CertificateExpirationDate 5/24/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024