11D2233534 CLIA NUMBER - MIDDLE MOODYCARE INC DBA POWELLS BLOOMFIELD PHARMACY

Laboratory Demographics

CLIA Number: 11D2233534

Facility Name: MIDDLE MOODYCARE INC DBA POWELLS BLOOMFIELD PHARMACY

Facility Address:
4839 BLOOMFIELD ROAD
MACON, GA
ZIP 31206
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Facility Phone Number: 478 781-1213

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1801881545

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	11D2233534
LAB Type	Pharmacy
Facility Name	MIDDLE MOODYCARE INC DBA POWELLS BLOOMFIELD PHARMACY
Street	4839 BLOOMFIELD ROAD
City	MACON
State	GA
ZIP	31206
Phone	478 781-1213
CertificateType	4
CertificateEffectiveDate	8/24/2023
CertificateExpirationDate	8/23/2025
FacilityType	Waiver

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