14D2119888 CLIA NUMBER - DALE'S SOUTHLAKE PHARMACY

Home > CLIA Lookup > 14D2119888

Laboratory Demographics

CLIA Number: 14D2119888

Facility Name: DALE'S SOUTHLAKE PHARMACY

Facility Address:
245 WEST 1ST DRIVE
DECATUR, IL
ZIP 62521
Get Directions

Facility Phone Number: 217 429-5165

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1588613384

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	14D2119888
LAB Type	Pharmacy
Facility Name	DALE'S SOUTHLAKE PHARMACY
Street	245 WEST 1ST DRIVE
City	DECATUR
State	IL
ZIP	62521
Phone	217 429-5165
CertificateType	4
CertificateEffectiveDate	10/5/2022
CertificateExpirationDate	10/4/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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