10D2131749 CLIA NUMBER - MEDOZ PHARMACY OF POLK INC

Laboratory Demographics

CLIA Number: 10D2131749

Facility Name: MEDOZ PHARMACY OF POLK INC

Facility Address:
40230 US HWY 27 SUITES 100-110
DAVENPORT, FL
ZIP 33837
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Facility Phone Number: 855 633-6948

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1962809475

Taxonomy: 3336C0004X - Pharmacy
A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner's Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice.

CLIA Record

Field Name	Field Value
CLIA Number	10D2131749
LAB Type	Pharmacy
Facility Name	MEDOZ PHARMACY OF POLK INC
Street	40230 US HWY 27 SUITES 100-110
City	DAVENPORT
State	FL
ZIP	33837
Phone	855 633-6948
CertificateType	4
CertificateEffectiveDate	6/6/2023
CertificateExpirationDate	6/5/2025
FacilityType	Waiver

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