42D2285086 CLIA NUMBER - SOUTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #02191

Laboratory Demographics

CLIA Number: 42D2285086

Facility Name: SOUTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #02191

Facility Address:
4102 OLD BUNCOMBE ROAD
GREENVILLE, SC
ZIP 29617
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Facility Phone Number: 864 371-3651

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1720182520

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	42D2285086
LAB Type	Pharmacy
Facility Name	SOUTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #02191
Street	4102 OLD BUNCOMBE ROAD
City	GREENVILLE
State	SC
ZIP	29617
Phone	864 371-3651
CertificateType	4
CertificateEffectiveDate	7/6/2023
CertificateExpirationDate	7/5/2025
FacilityType	Waiver

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