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14D2282895 CLIA NUMBER - CVS/PHARMACY #08661

Laboratory Demographics

CLIA Number: 14D2282895

Facility Name: CVS/PHARMACY #08661

Facility Address:
1316 CHARLESTON AVE
MATTOON, IL
ZIP 61938
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Facility Phone Number: 217 258-2929

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1063454254

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 14D2282895
LAB Type Pharmacy
Facility Name CVS/PHARMACY #08661
Street 1316 CHARLESTON AVE
City MATTOON
State IL
ZIP 61938
Phone 217 258-2929
CertificateType 4
CertificateEffectiveDate 5/26/2023
CertificateExpirationDate 5/25/2025
FacilityType Waiver

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