20D2230795 CLIA NUMBER - CVS STATE CAPITAL

Laboratory Demographics

CLIA Number: 20D2230795

Facility Name: CVS STATE CAPITAL

Facility Address:
1 KENNEDY MEMORIAL DRIVE
WATERVILLE, ME
ZIP 04901
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1508960428

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	20D2230795
LAB Type	Pharmacy
Facility Name	CVS STATE CAPITAL
Street	1 KENNEDY MEMORIAL DRIVE
City	WATERVILLE
State	ME
ZIP	04901
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	7/28/2023
CertificateExpirationDate	7/27/2025
FacilityType	Waiver

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