10D2088626 CLIA NUMBER - PUBLIX PHARMACY #1399

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Laboratory Demographics

CLIA Number: 10D2088626

Facility Name: PUBLIX PHARMACY #1399

Facility Address:
255 EAST VAN FLEET DR
BARTOW, FL
ZIP 33830
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Facility Phone Number: 863 534-1824

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1467735936

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	10D2088626
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1399
Street	255 EAST VAN FLEET DR
City	BARTOW
State	FL
ZIP	33830
Phone	863 534-1824
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