42D2255767 CLIA NUMBER - SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #04173

Laboratory Demographics

  • CLIA Code: 42D2255767
  • Facility Name: SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #04173
  • Facility Address: 1302 HWY 72-221 EAST
    GREENWOOD, SC
    ZIP 29649
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STACEY BASS
  • NPI Number: 1326534371
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 42D2255767
LAB Type Pharmacy
Facility Name SOUTH CAROLINA CVS PHARMACY LLC DBA CVS/PHARMACY #04173
Street 1302 HWY 72-221 EAST
City GREENWOOD
State SC
ZIP 29649
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 3/17/2024
Certificate Expiration Date 3/16/2026
Facility Type Pharmacy
Lab Director STACEY BASS

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