11D2282915 CLIA NUMBER - GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #00962

Laboratory Demographics

CLIA Number: 11D2282915

Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #00962

Facility Address:
1035 LOWER FAYETTEVILLE ROAD
NEWNAN, GA
ZIP 30265
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Facility Phone Number: 678 423-8891

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1720122880

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	11D2282915
LAB Type	Pharmacy
Facility Name	GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #00962
Street	1035 LOWER FAYETTEVILLE ROAD
City	NEWNAN
State	GA
ZIP	30265
Phone	678 423-8891
CertificateType	4
CertificateEffectiveDate	5/30/2023
CertificateExpirationDate	5/29/2025
FacilityType	Waiver

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