34D2232342 CLIA NUMBER - OLD MAIN PHARMACY

Laboratory Demographics

CLIA Number: 34D2232342

Facility Name: OLD MAIN PHARMACY

Facility Address:
407 WEST THIRD STREET
PEMBROKE, NC
ZIP 28372
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Facility Phone Number: 910 521-5600

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1649528613

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	34D2232342
LAB Type	Pharmacy
Facility Name	OLD MAIN PHARMACY
Street	407 WEST THIRD STREET
City	PEMBROKE
State	NC
ZIP	28372
Phone	910 521-5600
CertificateType	4
CertificateEffectiveDate	8/12/2023
CertificateExpirationDate	8/11/2025
FacilityType	Waiver

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