21D2285289 CLIA NUMBER - MARYLAND CVS LLC DBA CVS/PHARMACY #05460

Laboratory Demographics

  • CLIA Code: 21D2285289
  • Facility Name: MARYLAND CVS LLC DBA CVS/PHARMACY #05460
  • Facility Address: 19901 FREDERICK RD
    GERMANTOWN, MD
    ZIP 20876
  • Facility Phone: 301 916-7767
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ULRICH MBAKOP
  • NPI Number: 1336248780
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 21D2285289
LAB Type Pharmacy
Facility Name MARYLAND CVS LLC DBA CVS/PHARMACY #05460
Street 19901 FREDERICK RD
City GERMANTOWN
State MD
ZIP 20876
Phone 301 916-7767
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Pharmacy
Lab Director ULRICH MBAKOP

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