50D2220957 CLIA NUMBER - CVS/PHARMACY #16203

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Laboratory Demographics

CLIA Number: 50D2220957

Facility Name: CVS/PHARMACY #16203

Facility Address:
26301 104TH AVE SE
KENT, WA
ZIP 98030
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Facility Phone Number: 253 518-1190

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1568484251

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	50D2220957
LAB Type	Pharmacy
Facility Name	CVS/PHARMACY #16203
Street	26301 104TH AVE SE
City	KENT
State	WA
ZIP	98030
Phone	253 518-1190
CertificateType	4
CertificateEffectiveDate	4/16/2021
CertificateExpirationDate	4/4/2028
FacilityType	Waiver

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