11D2095557 CLIA NUMBER - PUBLIX PHARMACY #0789

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Laboratory Demographics

CLIA Number: 11D2095557

Facility Name: PUBLIX PHARMACY #0789

Facility Address:
2715 LOGANVILLE HWY
LOGANVILLE, GA
ZIP 30052
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Facility Phone Number: 770 822-2852

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1700825718

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	11D2095557
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0789
Street	2715 LOGANVILLE HWY
City	LOGANVILLE
State	GA
ZIP	30052
Phone	770 822-2852
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