34D2221516 CLIA NUMBER - NORTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #04098

Laboratory Demographics

CLIA Number: 34D2221516

Facility Name: NORTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #04098

Facility Address:
4300 OLD MONROE ROAD
INDIAN TRAIL, NC
ZIP 28079
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1730282369

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	34D2221516
LAB Type	Pharmacy
Facility Name	NORTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #04098
Street	4300 OLD MONROE ROAD
City	INDIAN TRAIL
State	NC
ZIP	28079
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	4/22/2023
CertificateExpirationDate	4/21/2025
FacilityType	Waiver

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