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39D2283854 CLIA NUMBER - CVS/PHARMACY #01188

Laboratory Demographics

CLIA Number: 39D2283854

Facility Name: CVS/PHARMACY #01188

Facility Address:
101 S MAIN ST
OLD FORGE, PA
ZIP 18518
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Facility Phone Number: 570 457-2182

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1801009196

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 39D2283854
LAB Type Pharmacy
Facility Name CVS/PHARMACY #01188
Street 101 S MAIN ST
City OLD FORGE
State PA
ZIP 18518
Phone 570 457-2182
CertificateType 4
CertificateEffectiveDate 6/14/2023
CertificateExpirationDate 6/13/2025
FacilityType Waiver

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