10D2088524 CLIA NUMBER - PUBLIX PHARMACY #1262

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Laboratory Demographics

CLIA Number: 10D2088524

Facility Name: PUBLIX PHARMACY #1262

Facility Address:
16980 ALICO MISSION WAY STE 403
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 239 489-0729

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861720468

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	10D2088524
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1262
Street	16980 ALICO MISSION WAY STE 403
City	FORT MYERS
State	FL
ZIP	33908
Phone	239 489-0729
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