14D2202682 CLIA NUMBER - PETERSBURG PHARMACY

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Laboratory Demographics

CLIA Number: 14D2202682

Facility Name: PETERSBURG PHARMACY

Facility Address:
1 CENTRE DRIVE STE 100
PETERSBURG, IL
ZIP 62675
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Facility Phone Number: 217 632-7777

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1538259403

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	14D2202682
LAB Type	Pharmacy
Facility Name	PETERSBURG PHARMACY
Street	1 CENTRE DRIVE STE 100
City	PETERSBURG
State	IL
ZIP	62675
Phone	217 632-7777
CertificateType	4
CertificateEffectiveDate	11/30/2022
CertificateExpirationDate	11/29/2024
FacilityType	Waiver

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