14D2255423 CLIA NUMBER - SHIELDS FAMILY PHARMACY

Laboratory Demographics

CLIA Number: 14D2255423

Facility Name: SHIELDS FAMILY PHARMACY

Facility Address:
1 PROFESSIONAL DR - STE 170
ALTON, IL
ZIP 62002
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Facility Phone Number: 618 463-0000

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1982001996

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	14D2255423
LAB Type	Pharmacy
Facility Name	SHIELDS FAMILY PHARMACY
Street	1 PROFESSIONAL DR - STE 170
City	ALTON
State	IL
ZIP	62002
Phone	618 463-0000
CertificateType	4
CertificateEffectiveDate	3/15/2024
CertificateExpirationDate	3/14/2026
FacilityType	Waiver

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