19D2284140 CLIA NUMBER - CVS PHARMACY #04743 LOUISIANA CVS PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 19D2284140
  • Facility Name: CVS PHARMACY #04743 LOUISIANA CVS PHARMACY LLC
  • Facility Address: 9510 ELLERBE RD
    SHREVEPORT, LA
    ZIP 71106
  • Facility Phone: 318 797-3272
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TOYET HANG KOUNTZ
  • NPI Number: 1902176142
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 19D2284140
LAB Type Pharmacy
Facility Name CVS PHARMACY #04743 LOUISIANA CVS PHARMACY LLC
Street 9510 ELLERBE RD
City SHREVEPORT
State LA
ZIP 71106
Phone 318 797-3272
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/19/2025
Certificate Expiration Date 6/18/2027
Facility Type Pharmacy
Lab Director TOYET HANG KOUNTZ

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This page was last updated on: 9/29/2025