11D2187771 CLIA NUMBER - YOUR CORNER DRUG STORE

Laboratory Demographics

CLIA Number: 11D2187771

Facility Name: YOUR CORNER DRUG STORE

Facility Address:
4260 LOG CABIN DRIVE SUITE C
MACON, GA
ZIP 31204
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Facility Phone Number: 478 254-8484

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1629433529

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	11D2187771
LAB Type	Pharmacy
Facility Name	YOUR CORNER DRUG STORE
Street	4260 LOG CABIN DRIVE SUITE C
City	MACON
State	GA
ZIP	31204
Phone	478 254-8484
CertificateType	4
CertificateEffectiveDate	7/7/2022
CertificateExpirationDate	7/6/2024
FacilityType	Waiver

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