19D2183294 CLIA NUMBER - SUPER 1 PHARMACY #603

Laboratory Demographics

CLIA Number: 19D2183294

Facility Name: SUPER 1 PHARMACY #603

Facility Address:
2211 E MADISON
BASTROP, LA
ZIP 71220
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Facility Phone Number: 318 281-3284

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1306919873

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	19D2183294
LAB Type	Pharmacy
Facility Name	SUPER 1 PHARMACY #603
Street	2211 E MADISON
City	BASTROP
State	LA
ZIP	71220
Phone	318 281-3284
CertificateType	4
CertificateEffectiveDate	5/4/2022
CertificateExpirationDate	5/3/2024
FacilityType	Waiver

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