42D2217228 CLIA NUMBER - SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #00175

Laboratory Demographics

  • CLIA Code: 42D2217228
  • Facility Name: SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #00175
  • Facility Address: 578 INTERNATIONAL DRIVE
    MYRTLE BEACH, SC
    ZIP 29579
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DONNA MILLS
  • NPI Number: 1508347931
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 42D2217228
LAB Type Pharmacy
Facility Name SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #00175
Street 578 INTERNATIONAL DRIVE
City MYRTLE BEACH
State SC
ZIP 29579
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 3/18/2025
Certificate Expiration Date 3/17/2027
Facility Type Pharmacy
Lab Director DONNA MILLS

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This page was last updated on: 3/20/2025