34D2236484 CLIA NUMBER - MITCHELL & JOHNNSON PHARMACY, INC DBA ISLAND PHARMACY

Laboratory Demographics

CLIA Number: 34D2236484

Facility Name: MITCHELL & JOHNNSON PHARMACY, INC DBA ISLAND PHARMACY

Facility Address:
2181-A OLD MOUNTAIN ROAD
STATESVILLE, NC
ZIP 28687
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Facility Phone Number: 704 873-0000

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1861406118

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	34D2236484
LAB Type	Pharmacy
Facility Name	MITCHELL & JOHNNSON PHARMACY, INC DBA ISLAND PHARMACY
Street	2181-A OLD MOUNTAIN ROAD
City	STATESVILLE
State	NC
ZIP	28687
Phone	704 873-0000
CertificateType	4
CertificateEffectiveDate	9/17/2023
CertificateExpirationDate	9/16/2025
FacilityType	Waiver

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