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10D2215063 CLIA NUMBER - ST MARY PHARMACY COMPOUNDING AND MEDICAL SUPPLIES

Laboratory Demographics

CLIA Number: 10D2215063

Facility Name: ST MARY PHARMACY COMPOUNDING AND MEDICAL SUPPLIES

Facility Address:
1314 S BAY STREET
EUSTIS, FL
ZIP 32726
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Facility Phone Number: 352 357-6699

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1811442502

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 10D2215063
LAB Type Pharmacy
Facility Name ST MARY PHARMACY COMPOUNDING AND MEDICAL SUPPLIES
Street 1314 S BAY STREET
City EUSTIS
State FL
ZIP 32726
Phone 352 357-6699
CertificateType 4
CertificateEffectiveDate 2/26/2023
CertificateExpirationDate 2/25/2025
FacilityType Waiver

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