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

Laboratory Demographics

  • CLIA Code: 45D2225234
  • Facility Name: CVS PHARMACY, INC DBA CVS/PHARMACY #04109
  • Facility Address: 12835 POTRANCO ROAD
    SAN ANTONIO, TX
    ZIP 78253
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: EMMANUEL AMEDZROVI
  • NPI Number: 1386901213
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director EMMANUEL AMEDZROVI

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