33D2261646 CLIA NUMBER - CVS PHARMACY NO 05104

Laboratory Demographics

  • CLIA Code: 33D2261646
  • Facility Name: CVS PHARMACY NO 05104
  • Facility Address: 496 COUNTY RD 111 - BLDG C
    MANORVILLE, NY
    ZIP 11949
  • Facility Phone: 631 399-0324
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. RAY M. KING
  • NPI Number: 1609156074
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 33D2261646
LAB Type Pharmacy
Facility Name CVS PHARMACY NO 05104
Street 496 COUNTY RD 111 - BLDG C
City MANORVILLE
State NY
ZIP 11949
Phone 631 399-0324
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2022
Certificate Expiration Date 3/26/2027
Facility Type Pharmacy
Lab Director MR. RAY M. KING

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