42D2218275 CLIA NUMBER - SOUTH CAROLINA CVS PHARMACY DBA CVS/PHARMACY #16825

Laboratory Demographics

CLIA Number: 42D2218275

Facility Name: SOUTH CAROLINA CVS PHARMACY DBA CVS/PHARMACY #16825

Facility Address:
450 AZALEA SQUARE BLVD
SUMMERVILLE, SC
ZIP 29483
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Facility Phone Number: 401 770-6431

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1245252998

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	42D2218275
LAB Type	Pharmacy
Facility Name	SOUTH CAROLINA CVS PHARMACY DBA CVS/PHARMACY #16825
Street	450 AZALEA SQUARE BLVD
City	SUMMERVILLE
State	SC
ZIP	29483
Phone	401 770-6431
CertificateType	4
CertificateEffectiveDate	3/26/2023
CertificateExpirationDate	3/25/2025
FacilityType	Waiver

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