19D2283949 CLIA NUMBER - CVS PHARMACY #10218 LOUISIANA CVS PHARMACY LLC

Laboratory Demographics

CLIA Number: 19D2283949

Facility Name: CVS PHARMACY #10218 LOUISIANA CVS PHARMACY LLC

Facility Address:
4870 AIRLINE DR
BOSSIER CITY, LA
ZIP 71111
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Facility Phone Number: 318 746-2924

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1568895761

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	19D2283949
LAB Type	Pharmacy
Facility Name	CVS PHARMACY #10218 LOUISIANA CVS PHARMACY LLC
Street	4870 AIRLINE DR
City	BOSSIER CITY
State	LA
ZIP	71111
Phone	318 746-2924
CertificateType	4
CertificateEffectiveDate	6/14/2023
CertificateExpirationDate	6/13/2025
FacilityType	Waiver

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