11D2093212 CLIA NUMBER - PUBLIX PHARMACY #1349

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Laboratory Demographics

CLIA Number: 11D2093212

Facility Name: PUBLIX PHARMACY #1349

Facility Address:
1212 US HIGHWAY 19 SOUTH
LEESBURG, GA
ZIP 31763
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Facility Phone Number: 229 431-0569

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1477866440

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	11D2093212
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1349
Street	1212 US HIGHWAY 19 SOUTH
City	LEESBURG
State	GA
ZIP	31763
Phone	229 431-0569
CertificateType	4
CertificateEffectiveDate	3/24/2023
CertificateExpirationDate	3/23/2025
FacilityType	Waiver

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