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25D2262602 CLIA NUMBER - MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY05925

Laboratory Demographics

CLIA Number: 25D2262602

Facility Name: MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY05925

Facility Address:
1600 E COUNTY LINE RD
RIDGELAND, MS
ZIP 39157
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Facility Phone Number: 601 957-1874

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1770682080

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 25D2262602
LAB Type Pharmacy
Facility Name MISSISSIPPI CVS PHARMACY LLC DBA CVS PHARMACY05925
Street 1600 E COUNTY LINE RD
City RIDGELAND
State MS
ZIP 39157
Phone 601 957-1874
CertificateType 4
CertificateEffectiveDate 6/15/2022
CertificateExpirationDate 6/14/2024
FacilityType Waiver

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