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20D2225269 CLIA NUMBER - CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00959

Laboratory Demographics

CLIA Number: 20D2225269

Facility Name: CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00959

Facility Address:
11 STEEPLE WAY, PO BOX 130
WELLS, ME
ZIP 04090
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1588811699

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 20D2225269
LAB Type Pharmacy
Facility Name CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00959
Street 11 STEEPLE WAY, PO BOX 130
City WELLS
State ME
ZIP 04090
Phone 866 389-2727
CertificateType 4
CertificateEffectiveDate 5/20/2023
CertificateExpirationDate 5/19/2025
FacilityType Waiver

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