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39D2225632 CLIA NUMBER - CVS/PHARMACY #02000

Laboratory Demographics

CLIA Number: 39D2225632

Facility Name: CVS/PHARMACY #02000

Facility Address:
3601 CHICHESTER RD, SUITE 105
BOOTHWYN, PA
ZIP 19061
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1104920958

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 39D2225632
LAB Type Pharmacy
Facility Name CVS/PHARMACY #02000
Street 3601 CHICHESTER RD, SUITE 105
City BOOTHWYN
State PA
ZIP 19061
Phone 401 770-6431
CertificateType 4
CertificateEffectiveDate 5/22/2023
CertificateExpirationDate 5/21/2025
FacilityType Waiver

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