10D0924644 CLIA NUMBER - SOUTHEAST FAMILY HEALTHCARE CENTER

Laboratory Demographics

CLIA Number: 10D0924644

Facility Name: SOUTHEAST FAMILY HEALTHCARE CENTER

Facility Address:
919 53RD AVE E
BRADENTON, FL
ZIP 34203
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Facility Phone Number: 941 960-9907

Facility Type: Community Clinic

Certificate Type: Waiver

NPI Number: 1295769362

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	10D0924644
LAB Type	Community Clinic
Facility Name	SOUTHEAST FAMILY HEALTHCARE CENTER
Street	919 53RD AVE E
City	BRADENTON
State	FL
ZIP	34203
Phone	941 960-9907
CertificateType	4
CertificateEffectiveDate	2/5/2023
CertificateExpirationDate	2/4/2025
FacilityType	Waiver

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