10D2193791 CLIA NUMBER - SIDDH INC DBA SAN CARLOS PHARMACY

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Laboratory Demographics

CLIA Number: 10D2193791

Facility Name: SIDDH INC DBA SAN CARLOS PHARMACY

Facility Address:
18911 S TAMIAMI TRAIL SUITE 13
FORT MYERS, FL
ZIP 33908
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Facility Phone Number: 239 590-8820

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1891152989

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	10D2193791
LAB Type	Pharmacy
Facility Name	SIDDH INC DBA SAN CARLOS PHARMACY
Street	18911 S TAMIAMI TRAIL SUITE 13
City	FORT MYERS
State	FL
ZIP	33908
Phone	239 590-8820
CertificateType	4
CertificateEffectiveDate	9/24/2022
CertificateExpirationDate	9/23/2024
FacilityType	Waiver

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