26D2218015 CLIA NUMBER - MISSOURI CVS PHARMACY, LLC DBA CVS/PHARMACY #16476

Laboratory Demographics

CLIA Number: 26D2218015

Facility Name: MISSOURI CVS PHARMACY, LLC DBA CVS/PHARMACY #16476

Facility Address:
25 BRENTWOOD PROMENADE CT
BRENTWOOD, MO
ZIP 63144
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1639436181

Taxonomy: 261QD0000X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	26D2218015
LAB Type	Pharmacy
Facility Name	MISSOURI CVS PHARMACY, LLC DBA CVS/PHARMACY #16476
Street	25 BRENTWOOD PROMENADE CT
City	BRENTWOOD
State	MO
ZIP	63144
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	3/25/2023
CertificateExpirationDate	3/24/2025
FacilityType	Waiver

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