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20D2225275 CLIA NUMBER - CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00805

Laboratory Demographics

CLIA Number: 20D2225275

Facility Name: CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00805

Facility Address:
335 OCEAN HOUSE ROAD
CAPE ELIZABETH, ME
ZIP 04107
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Facility Phone Number: 855 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1407950322

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 20D2225275
LAB Type Pharmacy
Facility Name CVS STATE CAPITAL, LLC DBA CVS/PHARMACY #00805
Street 335 OCEAN HOUSE ROAD
City CAPE ELIZABETH
State ME
ZIP 04107
Phone 855 389-2727
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