10D2088432 CLIA NUMBER - PUBLIX PHARMACY #0775

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Laboratory Demographics

CLIA Number: 10D2088432

Facility Name: PUBLIX PHARMACY #0775

Facility Address:
15880 SUMMERLIN RD
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 239 433-1684

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1609816552

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	10D2088432
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0775
Street	15880 SUMMERLIN RD
City	FORT MYERS
State	FL
ZIP	33908
Phone	239 433-1684
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