11D2095534 CLIA NUMBER - PUBLIX PHARMACY #0665

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Laboratory Demographics

CLIA Number: 11D2095534

Facility Name: PUBLIX PHARMACY #0665

Facility Address:
3870 N DRUID HILLS RD
DECATUR, GA
ZIP 30033
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Facility Phone Number: 404 633-6466

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306880984

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	11D2095534
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0665
Street	3870 N DRUID HILLS RD
City	DECATUR
State	GA
ZIP	30033
Phone	404 633-6466
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