26D2187889 CLIA NUMBER - MEDICENTER PHARMACY

Laboratory Demographics

CLIA Number: 26D2187889

Facility Name: MEDICENTER PHARMACY

Facility Address:
1474 N BOONVILLE
SPRINGFIELD, MO
ZIP 65802
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Facility Phone Number: 417 869-1866

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1013089804

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	26D2187889
LAB Type	Pharmacy
Facility Name	MEDICENTER PHARMACY
Street	1474 N BOONVILLE
City	SPRINGFIELD
State	MO
ZIP	65802
Phone	417 869-1866
CertificateType	4
CertificateEffectiveDate	7/9/2022
CertificateExpirationDate	7/8/2024
FacilityType	Waiver

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