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

Laboratory Demographics

  • CLIA Code: 42D2285086
  • Facility Name: SOUTH CAROLINA CVS PHARMACY, LLC DBA CVS PHARMACY #02191
  • Facility Address: 4102 OLD BUNCOMBE ROAD
    GREENVILLE, SC
    ZIP 29617
  • Facility Phone: 864 371-3651
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COURTNEY BAKER
  • NPI Number: 1720182520
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Pharmacy
Lab Director COURTNEY BAKER

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