31D2223919 CLIA NUMBER - NEW JERSEY CVS PHARMACY, LLC DBA PHARMACY #01158

Laboratory Demographics

  • CLIA Code: 31D2223919
  • Facility Name: NEW JERSEY CVS PHARMACY, LLC DBA PHARMACY #01158
  • Facility Address: 213-217 HARRISON STREET
    NUTLEY, NJ
    ZIP 07110
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTIAN GONGOB
  • NPI Number: 1093807711
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 31D2223919
LAB Type Pharmacy
Facility Name NEW JERSEY CVS PHARMACY, LLC DBA PHARMACY #01158
Street 213-217 HARRISON STREET
City NUTLEY
State NJ
ZIP 07110
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2025
Certificate Expiration Date 5/10/2027
Facility Type Pharmacy
Lab Director CHRISTIAN GONGOB

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