11D0975553 CLIA NUMBER - PHILLIPS PHARMACY

Laboratory Demographics

  • CLIA Code: 11D0975553
  • Facility Name: PHILLIPS PHARMACY
  • Facility Address: 306 WEST FIRST STREET
    VIDALIA, GA
    ZIP 30474
  • Facility Phone: 912 537-3049
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PAUL R. COMBS
  • NPI Number: 1437214012
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 11D0975553
LAB Type Pharmacy
Facility Name PHILLIPS PHARMACY
Street 306 WEST FIRST STREET
City VIDALIA
State GA
ZIP 30474
Phone 912 537-3049
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2024
Certificate Expiration Date 7/10/2026
Facility Type Pharmacy
Lab Director PAUL R. COMBS

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This page was last updated on: 9/29/2025