45D2273686 CLIA NUMBER - CVS PHARMACY, INC. DBA CVS/PHARMACY #10436

Laboratory Demographics

  • CLIA Code: 45D2273686
  • Facility Name: CVS PHARMACY, INC. DBA CVS/PHARMACY #10436
  • Facility Address: 5201 GOLDEN TRIANGLE BLVD
    FORT WORTH, TX
    ZIP 76244
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IKENNA MODEBELU
  • NPI Number: 1386151157
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2273686
LAB Type Pharmacy
Facility Name CVS PHARMACY, INC. DBA CVS/PHARMACY #10436
Street 5201 GOLDEN TRIANGLE BLVD
City FORT WORTH
State TX
ZIP 76244
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 12/16/2024
Certificate Expiration Date 12/15/2026
Facility Type Pharmacy
Lab Director IKENNA MODEBELU

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