11D2193122 CLIA NUMBER - PRUITTHEALTH PHARMACY SERVICES- ATLANTA, INC

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Laboratory Demographics

CLIA Number: 11D2193122

Facility Name: PRUITTHEALTH PHARMACY SERVICES- ATLANTA, INC

Facility Address:
1626 JEURGENS COURT SUITE A
NORCROSS, GA
ZIP 30093
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Facility Phone Number: 678 533-6459

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1346385333

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	11D2193122
LAB Type	Pharmacy
Facility Name	PRUITTHEALTH PHARMACY SERVICES- ATLANTA, INC
Street	1626 JEURGENS COURT SUITE A
City	NORCROSS
State	GA
ZIP	30093
Phone	678 533-6459
CertificateType	4
CertificateEffectiveDate	9/17/2022
CertificateExpirationDate	9/16/2024
FacilityType	Waiver

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