31D2216640 CLIA NUMBER - SICOMAC PHARMACY

Laboratory Demographics

CLIA Number: 31D2216640

Facility Name: SICOMAC PHARMACY

Facility Address:
300 SICOMAC AVE STE 1
WYCKOFF, NJ
ZIP 07481
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Facility Phone Number: 201 891-0822

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1912901323

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	31D2216640
LAB Type	Pharmacy
Facility Name	SICOMAC PHARMACY
Street	300 SICOMAC AVE STE 1
City	WYCKOFF
State	NJ
ZIP	07481
Phone	201 891-0822
CertificateType	4
CertificateEffectiveDate	3/15/2023
CertificateExpirationDate	3/14/2025
FacilityType	Waiver

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