36D2279404 CLIA NUMBER - OHIO CVS STORES, LLC CVSPHARMACY #04802

Laboratory Demographics

  • CLIA Code: 36D2279404
  • Facility Name: OHIO CVS STORES, LLC CVSPHARMACY #04802
  • Facility Address: 600 WEST MAPLE ST
    HARTVILLE, OH
    ZIP 44632
  • Facility Phone: 330 877-0311
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TILLAKOS PARANOMITIS
  • NPI Number: 1891898557
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 36D2279404
LAB Type Pharmacy
Facility Name OHIO CVS STORES, LLC CVSPHARMACY #04802
Street 600 WEST MAPLE ST
City HARTVILLE
State OH
ZIP 44632
Phone 330 877-0311
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2025
Certificate Expiration Date 4/2/2027
Facility Type Pharmacy
Lab Director TILLAKOS PARANOMITIS

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