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10D2124586 CLIA NUMBER - PUBLIX PHARMACY #0770

Laboratory Demographics

CLIA Number: 10D2124586

Facility Name: PUBLIX PHARMACY #0770

Facility Address:
8301 CHAMPIONS GATE BLVD
DAVENPORT, FL
ZIP 33896
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Facility Phone Number: 813 397-8279

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1891958716

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 10D2124586
LAB Type Pharmacy
Facility Name PUBLIX PHARMACY #0770
Street 8301 CHAMPIONS GATE BLVD
City DAVENPORT
State FL
ZIP 33896
Phone 813 397-8279
CertificateType 4
CertificateEffectiveDate 1/20/2023
CertificateExpirationDate 1/19/2025
FacilityType Waiver

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