10D2092303 CLIA NUMBER - PUBLIX PHARMACY #1124

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Laboratory Demographics

CLIA Number: 10D2092303

Facility Name: PUBLIX PHARMACY #1124

Facility Address:
3500 DAVIE BLVD
FORT LAUDERDALE, FL
ZIP 33312
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Facility Phone Number: 954 587-2130

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1154711885

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	10D2092303
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1124
Street	3500 DAVIE BLVD
City	FORT LAUDERDALE
State	FL
ZIP	33312
Phone	954 587-2130
CertificateType	4
CertificateEffectiveDate	3/3/2023
CertificateExpirationDate	3/2/2025
FacilityType	Waiver

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