21D2081902 CLIA NUMBER - SAFEWAY PHARMACY #0105

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Laboratory Demographics

CLIA Number: 21D2081902

Facility Name: SAFEWAY PHARMACY #0105

Facility Address:
10 KING STREET
WALDORF, MD
ZIP 20602
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Facility Phone Number: 208 395-3963

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1952519696

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	21D2081902
LAB Type	Pharmacy
Facility Name	SAFEWAY PHARMACY #0105
Street	10 KING STREET
City	WALDORF
State	MD
ZIP	20602
Phone	208 395-3963
CertificateType	4
CertificateEffectiveDate	8/4/2022
CertificateExpirationDate	8/3/2024
FacilityType	Waiver

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