45D2225234 CLIA NUMBER - CVS PHARMACY, INC DBA CVS/PHARMACY #04109

Laboratory Demographics

CLIA Number: 45D2225234

Facility Name: CVS PHARMACY, INC DBA CVS/PHARMACY #04109

Facility Address:
12835 POTRANCO ROAD
SAN ANTONIO, TX
ZIP 78253
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Facility Phone Number: 866 389-2727

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1386901213

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	45D2225234
LAB Type	Pharmacy
Facility Name	CVS PHARMACY, INC DBA CVS/PHARMACY #04109
Street	12835 POTRANCO ROAD
City	SAN ANTONIO
State	TX
ZIP	78253
Phone	866 389-2727
CertificateType	4
CertificateEffectiveDate	5/19/2023
CertificateExpirationDate	5/18/2025
FacilityType	Waiver

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