33D2211715 CLIA NUMBER - SOUTHSHORE PHARMACY CORP

Laboratory Demographics

CLIA Number: 33D2211715

Facility Name: SOUTHSHORE PHARMACY CORP

Facility Address:
4020 HYLAN BLVD
STATEN ISLAND, NY
ZIP 10308
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Facility Phone Number: 718 948-4848

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1417183518

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	33D2211715
LAB Type	Pharmacy
Facility Name	SOUTHSHORE PHARMACY CORP
Street	4020 HYLAN BLVD
City	STATEN ISLAND
State	NY
ZIP	10308
Phone	718 948-4848
CertificateType	4
CertificateEffectiveDate	1/29/2021
CertificateExpirationDate	3/26/2027
FacilityType	Waiver

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