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14D2283746 CLIA NUMBER - CVS/PHARMACY #06831

Laboratory Demographics

CLIA Number: 14D2283746

Facility Name: CVS/PHARMACY #06831

Facility Address:
2701 GODFREY RD
GODFREY, IL
ZIP 62035
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Facility Phone Number: 618 466-1211

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1629171491

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 14D2283746
LAB Type Pharmacy
Facility Name CVS/PHARMACY #06831
Street 2701 GODFREY RD
City GODFREY
State IL
ZIP 62035
Phone 618 466-1211
CertificateType 4
CertificateEffectiveDate 6/13/2023
CertificateExpirationDate 6/12/2025
FacilityType Waiver

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