10D2143202 CLIA NUMBER - BROOKSVILLE RX LLC

Laboratory Demographics

CLIA Number: 10D2143202

Facility Name: BROOKSVILLE RX LLC

Facility Address:
80 PONCE DE LEON BLVD
BROOKSVILLE, FL
ZIP 34601
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Facility Phone Number: 352 796-4975

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1366149254

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	10D2143202
LAB Type	Pharmacy
Facility Name	BROOKSVILLE RX LLC
Street	80 PONCE DE LEON BLVD
City	BROOKSVILLE
State	FL
ZIP	34601
Phone	352 796-4975
CertificateType	4
CertificateEffectiveDate	1/13/2023
CertificateExpirationDate	1/12/2025
FacilityType	Waiver

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