10D2088519 CLIA NUMBER - PUBLIX PHARMACY #1039

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Laboratory Demographics

CLIA Number: 10D2088519

Facility Name: PUBLIX PHARMACY #1039

Facility Address:
11851 PALM BEACH BLVD
FORT MYERS, FL
ZIP 33905
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Facility Phone Number: 239 690-9570

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1104866417

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	10D2088519
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1039
Street	11851 PALM BEACH BLVD
City	FORT MYERS
State	FL
ZIP	33905
Phone	239 690-9570
CertificateType	4
CertificateEffectiveDate	12/16/2022
CertificateExpirationDate	12/15/2024
FacilityType	Waiver

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