10D1019500 CLIA NUMBER - PUBLIX PHARMACY #1204

Laboratory Demographics

  • CLIA Code: 10D1019500
  • Facility Name: PUBLIX PHARMACY #1204
  • Facility Address: 884 CYPRESS GARDENS BLVD
    WINTER HAVEN, FL
    ZIP 33880
  • Facility Phone: 863 293-2382
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WHIT TAYLOR
  • NPI Number: 1003063520
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 10D1019500
LAB Type Pharmacy
Facility Name PUBLIX PHARMACY #1204
Street 884 CYPRESS GARDENS BLVD
City WINTER HAVEN
State FL
ZIP 33880
Phone 863 293-2382
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/19/2024
Certificate Expiration Date 8/18/2026
Facility Type Pharmacy
Lab Director WHIT TAYLOR

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