18D2216732 CLIA NUMBER - KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06206

Laboratory Demographics

CLIA Number: 18D2216732

Facility Name: KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06206

Facility Address:
5121 ANTLE DRIVE
LOUISVILLE, KY
ZIP 40229
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477656114

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	18D2216732
LAB Type	Pharmacy
Facility Name	KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06206
Street	5121 ANTLE DRIVE
City	LOUISVILLE
State	KY
ZIP	40229
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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