18D2216786 CLIA NUMBER - KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06264

Laboratory Demographics

CLIA Number: 18D2216786

Facility Name: KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06264

Facility Address:
3311 HIGHWAY 54
OWENSBORO, KY
ZIP 42303
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1619165644

Taxonomy: 207RC0000X - Internal Medicine
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.

CLIA Record

Field Name	Field Value
CLIA Number	18D2216786
LAB Type	Pharmacy
Facility Name	KENTUCKY CVS PHARMACY, LLC DBA CVS / PHARMACY #06264
Street	3311 HIGHWAY 54
City	OWENSBORO
State	KY
ZIP	42303
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