10D2227758 CLIA NUMBER - PELICAN PHARMACY

Laboratory Demographics

CLIA Number: 10D2227758

Facility Name: PELICAN PHARMACY

Facility Address:
24830 S TAMIAMI TRAIL UNIT 1800
BONITA SPRINGS, FL
ZIP 34134
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Facility Phone Number: 239 319-0744

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1841887767

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	10D2227758
LAB Type	Pharmacy
Facility Name	PELICAN PHARMACY
Street	24830 S TAMIAMI TRAIL UNIT 1800
City	BONITA SPRINGS
State	FL
ZIP	34134
Phone	239 319-0744
CertificateType	4
CertificateEffectiveDate	6/16/2023
CertificateExpirationDate	6/15/2025
FacilityType	Waiver

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