39D2259109 CLIA NUMBER - CVS/PHARMACY #01631

Laboratory Demographics

  • CLIA Code: 39D2259109
  • Facility Name: CVS/PHARMACY #01631
  • Facility Address: 2200 WEST CUMBERLAND ST
    LEBANON, PA
    ZIP 17042
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW N. STATHIS
  • NPI Number: 1407957962
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 39D2259109
LAB Type Pharmacy
Facility Name CVS/PHARMACY #01631
Street 2200 WEST CUMBERLAND ST
City LEBANON
State PA
ZIP 17042
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2024
Certificate Expiration Date 5/1/2026
Facility Type Pharmacy
Lab Director MATTHEW N. STATHIS

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