10D2175306 CLIA NUMBER - PEDIATRIC ASSOCIATES

Laboratory Demographics

CLIA Number: 10D2175306

Facility Name: PEDIATRIC ASSOCIATES

Facility Address:
1327 WINTER GARDEN VINELAND RD SUITE 120
WINTER GARDEN, FL
ZIP 34787
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Facility Phone Number: 954 965-7754

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659031961

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	10D2175306
LAB Type	Physician Office
Facility Name	PEDIATRIC ASSOCIATES
Street	1327 WINTER GARDEN VINELAND RD SUITE 120
City	WINTER GARDEN
State	FL
ZIP	34787
Phone	954 965-7754
CertificateType	4
CertificateEffectiveDate	11/19/2023
CertificateExpirationDate	11/18/2025
FacilityType	Waiver

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