10D2088904 CLIA NUMBER - PUBLIX PHARMACY #1258

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Laboratory Demographics

CLIA Number: 10D2088904

Facility Name: PUBLIX PHARMACY #1258

Facility Address:
2038 US HWY 98 W
SANTA ROSA BEACH, FL
ZIP 32459
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Facility Phone Number: 850 267-1166

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1942431036

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	10D2088904
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1258
Street	2038 US HWY 98 W
City	SANTA ROSA BEACH
State	FL
ZIP	32459
Phone	850 267-1166
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