10D2088504 CLIA NUMBER - PUBLIX PHARMACY #0743

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Laboratory Demographics

CLIA Number: 10D2088504

Facility Name: PUBLIX PHARMACY #0743

Facility Address:
19441 SHERIDAN ST
FORT LAUDERDALE, FL
ZIP 33332
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Facility Phone Number: 954 434-5930

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1013957877

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	10D2088504
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0743
Street	19441 SHERIDAN ST
City	FORT LAUDERDALE
State	FL
ZIP	33332
Phone	954 434-5930
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