39D2223681 CLIA NUMBER - CVS/PHARMACY #01622

Laboratory Demographics

  • CLIA Code: 39D2223681
  • Facility Name: CVS/PHARMACY #01622
  • Facility Address: 1200 MARKET STREET
    LEMOYNE, PA
    ZIP 17043
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EDGAR SEBULONDE
  • NPI Number: 1194829929
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2223681
LAB Type Pharmacy
Facility Name CVS/PHARMACY #01622
Street 1200 MARKET STREET
City LEMOYNE
State PA
ZIP 17043
Phone 401 770-6431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2025
Certificate Expiration Date 5/7/2027
Facility Type Pharmacy
Lab Director EDGAR SEBULONDE

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