25D2223609 CLIA NUMBER - MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY08491

Laboratory Demographics

CLIA Number: 25D2223609

Facility Name: MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY08491

Facility Address:
2945 GOODMAN ROAD EAST
SOUTHAVEN, MS
ZIP 38672
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1417183922

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	25D2223609
LAB Type	Pharmacy
Facility Name	MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY08491
Street	2945 GOODMAN ROAD EAST
City	SOUTHAVEN
State	MS
ZIP	38672
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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