10D2088911 CLIA NUMBER - PUBLIX PHARMACY #1303

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Laboratory Demographics

CLIA Number: 10D2088911

Facility Name: PUBLIX PHARMACY #1303

Facility Address:
610 N EGLIN PKWY
FORT WALTON BEACH, FL
ZIP 32547
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Facility Phone Number: 850 862-6185

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1073767257

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	10D2088911
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1303
Street	610 N EGLIN PKWY
City	FORT WALTON BEACH
State	FL
ZIP	32547
Phone	850 862-6185
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