10D2240469 CLIA NUMBER - NIMOH PHARMACY AND COMPOUNDING LLC

Laboratory Demographics

CLIA Number: 10D2240469

Facility Name: NIMOH PHARMACY AND COMPOUNDING LLC

Facility Address:
12878 US HIGHWAY 301
DADE CITY, FL
ZIP 33525
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Facility Phone Number: 352 437-5985

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1053729418

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	10D2240469
LAB Type	Pharmacy
Facility Name	NIMOH PHARMACY AND COMPOUNDING LLC
Street	12878 US HIGHWAY 301
City	DADE CITY
State	FL
ZIP	33525
Phone	352 437-5985
CertificateType	4
CertificateEffectiveDate	10/20/2023
CertificateExpirationDate	10/19/2025
FacilityType	Waiver

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