10D1019502 CLIA NUMBER - PUBLIX PHARMACY #1111

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Laboratory Demographics

CLIA Number: 10D1019502

Facility Name: PUBLIX PHARMACY #1111

Facility Address:
2755 SW 91ST ST
GAINESVILLE, FL
ZIP 32608
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Facility Phone Number: 352 331-1086

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1659311124

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	10D1019502
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1111
Street	2755 SW 91ST ST
City	GAINESVILLE
State	FL
ZIP	32608
Phone	352 331-1086
CertificateType	4
CertificateEffectiveDate	12/15/2022
CertificateExpirationDate	12/14/2024
FacilityType	Waiver

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