21D2283769 CLIA NUMBER - MARYLAND CVS PHARMACY LLC DBA CVS PHARMACY #01880

Laboratory Demographics

  • CLIA Code: 21D2283769
  • Facility Name: MARYLAND CVS PHARMACY LLC DBA CVS PHARMACY #01880
  • Facility Address: 12825 WISTERIA DRIVE
    GERMANTOWN, MD
    ZIP 20874
  • Facility Phone: 301 540-1103
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEAN PIERRE NOUBISSI
  • NPI Number: 1255438743
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2283769
LAB Type Pharmacy
Facility Name MARYLAND CVS PHARMACY LLC DBA CVS PHARMACY #01880
Street 12825 WISTERIA DRIVE
City GERMANTOWN
State MD
ZIP 20874
Phone 301 540-1103
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/13/2025
Certificate Expiration Date 6/12/2027
Facility Type Pharmacy
Lab Director JEAN PIERRE NOUBISSI

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