11D2095452 CLIA NUMBER - PUBLIX PHARMACY #0753

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Laboratory Demographics

CLIA Number: 11D2095452

Facility Name: PUBLIX PHARMACY #0753

Facility Address:
4480 S COBB DR SE
SMYRNA, GA
ZIP 30080
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Facility Phone Number: 000 770-4348

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1942240809

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	11D2095452
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0753
Street	4480 S COBB DR SE
City	SMYRNA
State	GA
ZIP	30080
Phone	000 770-4348
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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