21D2226559 CLIA NUMBER - MARYLAND CVS PHARMACY LLC DBA CVS/PHARMACY #03047

Laboratory Demographics

  • CLIA Code: 21D2226559
  • Facility Name: MARYLAND CVS PHARMACY LLC DBA CVS/PHARMACY #03047
  • Facility Address: 8601 MARTIN LUTHER KING JR HWY
    LANHAM, MD
    ZIP 20706
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BON GYEOM KOO
  • NPI Number: 1851348536
  • Taxonomy: 261QM0801X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2226559
LAB Type Pharmacy
Facility Name MARYLAND CVS PHARMACY LLC DBA CVS/PHARMACY #03047
Street 8601 MARTIN LUTHER KING JR HWY
City LANHAM
State MD
ZIP 20706
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/2/2025
Certificate Expiration Date 6/1/2027
Facility Type Pharmacy
Lab Director BON GYEOM KOO

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