11D2249246 CLIA NUMBER - MITCH'S PHARMACY

Laboratory Demographics

CLIA Number: 11D2249246

Facility Name: MITCH'S PHARMACY

Facility Address:
5 E COFFEE STREET
HAZLEHURST, GA
ZIP 31539
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Facility Phone Number: 912 699-3784

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1295319945

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	11D2249246
LAB Type	Pharmacy
Facility Name	MITCH'S PHARMACY
Street	5 E COFFEE STREET
City	HAZLEHURST
State	GA
ZIP	31539
Phone	912 699-3784
CertificateType	4
CertificateEffectiveDate	1/19/2024
CertificateExpirationDate	1/18/2026
FacilityType	Waiver

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