30D2220797 CLIA NUMBER - CVS MANCHESTER NH, LLC DBA CVS/PHARMACY #02420

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Laboratory Demographics

CLIA Number: 30D2220797

Facility Name: CVS MANCHESTER NH, LLC DBA CVS/PHARMACY #02420

Facility Address:
177 MAMMOTH
LONDONDERRY, NH
ZIP 03053
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1780767046

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	30D2220797
LAB Type	Pharmacy
Facility Name	CVS MANCHESTER NH, LLC DBA CVS/PHARMACY #02420
Street	177 MAMMOTH
City	LONDONDERRY
State	NH
ZIP	03053
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	4/15/2023
CertificateExpirationDate	4/14/2025
FacilityType	Waiver

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