36D2185910 CLIA NUMBER - OHIO CVS STORES, LLC DBA CVS/PHARMACY #2063

Laboratory Demographics

CLIA Number: 36D2185910

Facility Name: OHIO CVS STORES, LLC DBA CVS/PHARMACY #2063

Facility Address:
7292 FULTON DRIVE NW
CANTON, OH
ZIP 44718
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1922398437

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	36D2185910
LAB Type	Pharmacy
Facility Name	OHIO CVS STORES, LLC DBA CVS/PHARMACY #2063
Street	7292 FULTON DRIVE NW
City	CANTON
State	OH
ZIP	44718
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	6/11/2022
CertificateExpirationDate	6/10/2024
FacilityType	Waiver

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