10D2096151 CLIA NUMBER - PUBLIX PHARMACY #1472

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Laboratory Demographics

CLIA Number: 10D2096151

Facility Name: PUBLIX PHARMACY #1472

Facility Address:
9335 SW COMMERCE CENTRE DR
PORT SAINT LUCIE, FL
ZIP 34986
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Facility Phone Number: 772 345-9505

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1982097523

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	10D2096151
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1472
Street	9335 SW COMMERCE CENTRE DR
City	PORT SAINT LUCIE
State	FL
ZIP	34986
Phone	772 345-9505
CertificateType	4
CertificateEffectiveDate	5/18/2023
CertificateExpirationDate	5/17/2025
FacilityType	Waiver

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