11D2095981 CLIA NUMBER - PUBLIX PHARMACY #1071

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Laboratory Demographics

CLIA Number: 11D2095981

Facility Name: PUBLIX PHARMACY #1071

Facility Address:
2880 GEORGIA HIGHWAY 212 SW
CONYERS, GA
ZIP 30094
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Facility Phone Number: 000 770-3880

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1710926753

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	11D2095981
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1071
Street	2880 GEORGIA HIGHWAY 212 SW
City	CONYERS
State	GA
ZIP	30094
Phone	000 770-3880
CertificateType	4
CertificateEffectiveDate	5/13/2023
CertificateExpirationDate	5/12/2025
FacilityType	Waiver

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