11D2095471 CLIA NUMBER - PUBLIX PHARMACY

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Laboratory Demographics

CLIA Number: 11D2095471

Facility Name: PUBLIX PHARMACY

Facility Address:
4300 CHAPEL HILL RD
DOUGLASVILLE, GA
ZIP 30135
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Facility Phone Number: 770 577-5139

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1427139443

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	11D2095471
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY
Street	4300 CHAPEL HILL RD
City	DOUGLASVILLE
State	GA
ZIP	30135
Phone	770 577-5139
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