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

Laboratory Demographics

  • CLIA Code: 11D2282915
  • Facility Name: GEORGIA CVS PHARMACY, LLC DBA CVS/PHARMACY #00962
  • Facility Address: 1035 LOWER FAYETTEVILLE ROAD
    NEWNAN, GA
    ZIP 30265
  • Facility Phone: 678 423-8891
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIM ROLLE
  • NPI Number: 1720122880
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/30/2025
Certificate Expiration Date 5/29/2027
Facility Type Pharmacy
Lab Director KIM ROLLE

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