10D2088735 CLIA NUMBER - PUBLIX PHARMACY #0827

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Laboratory Demographics

CLIA Number: 10D2088735

Facility Name: PUBLIX PHARMACY #0827

Facility Address:
1850 RIDGEWOOD AVE
HOLLY HILL, FL
ZIP 32117
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Facility Phone Number: 386 677-9495

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1952341331

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	10D2088735
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0827
Street	1850 RIDGEWOOD AVE
City	HOLLY HILL
State	FL
ZIP	32117
Phone	386 677-9495
CertificateType	4
CertificateEffectiveDate	12/17/2022
CertificateExpirationDate	12/16/2024
FacilityType	Waiver

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