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36D2216737 CLIA NUMBER - OHIO CVS STORES, LLC DBA CVS/PHARMACY #06169

Laboratory Demographics

CLIA Number: 36D2216737

Facility Name: OHIO CVS STORES, LLC DBA CVS/PHARMACY #06169

Facility Address:
1411 LEXINGTON AVENUE
MANSFIELD, OH
ZIP 44907
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1063515765

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 36D2216737
LAB Type Pharmacy
Facility Name OHIO CVS STORES, LLC DBA CVS/PHARMACY #06169
Street 1411 LEXINGTON AVENUE
City MANSFIELD
State OH
ZIP 44907
Phone 401 770-6431
CertificateType 4
CertificateEffectiveDate 3/16/2023
CertificateExpirationDate 3/15/2025
FacilityType Waiver

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