14D2235122 CLIA NUMBER - PRINCEVILLE PHARMACY

Laboratory Demographics

CLIA Number: 14D2235122

Facility Name: PRINCEVILLE PHARMACY

Facility Address:
206 E MAIN ST
PRINCEVILLE, IL
ZIP 61559
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Facility Phone Number: 309 385-4955

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1750455127

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	14D2235122
LAB Type	Pharmacy
Facility Name	PRINCEVILLE PHARMACY
Street	206 E MAIN ST
City	PRINCEVILLE
State	IL
ZIP	61559
Phone	309 385-4955
CertificateType	4
CertificateEffectiveDate	9/7/2023
CertificateExpirationDate	9/6/2025
FacilityType	Waiver

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