10D2088578 CLIA NUMBER - PUBLIX PHARMACY #1103

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Laboratory Demographics

CLIA Number: 10D2088578

Facility Name: PUBLIX PHARMACY #1103

Facility Address:
606 HAVENDALE BLVD
AUBURNDALE, FL
ZIP 33823
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Facility Phone Number: 863 551-9798

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1457390460

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	10D2088578
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1103
Street	606 HAVENDALE BLVD
City	AUBURNDALE
State	FL
ZIP	33823
Phone	863 551-9798
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