31D2210317 CLIA NUMBER - DIFFERX PHARMACY

Laboratory Demographics

CLIA Number: 31D2210317

Facility Name: DIFFERX PHARMACY

Facility Address:
492 CENTRAL AVE
JERSEY CITY, NJ
ZIP 07307
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Facility Phone Number: 201 716-2568

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1982109880

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	31D2210317
LAB Type	Pharmacy
Facility Name	DIFFERX PHARMACY
Street	492 CENTRAL AVE
City	JERSEY CITY
State	NJ
ZIP	07307
Phone	201 716-2568
CertificateType	4
CertificateEffectiveDate	1/21/2023
CertificateExpirationDate	1/20/2025
FacilityType	Waiver

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