41D1012311 CLIA NUMBER - WAKEFIELD PEDIATRICS LLC SOUTH RI PROFESSIONAL BUILDING SUITE 2

Laboratory Demographics

CLIA Number: 41D1012311

Facility Name: WAKEFIELD PEDIATRICS LLC SOUTH RI PROFESSIONAL BUILDING SUITE 2

Facility Address:
46 HOLLEY ST ATTN KAREN
WAKEFIELD, RI
ZIP 02879
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Facility Phone Number: 401 783-8008

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1780781120

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	41D1012311
LAB Type	Physician Office
Facility Name	WAKEFIELD PEDIATRICS LLC SOUTH RI PROFESSIONAL BUILDING SUITE 2
Street	46 HOLLEY ST ATTN KAREN
City	WAKEFIELD
State	RI
ZIP	02879
Phone	401 783-8008
CertificateType	4
CertificateEffectiveDate	5/7/2023
CertificateExpirationDate	5/6/2025
FacilityType	Waiver

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