42D0991908 CLIA NUMBER - PUBLIX PHARMACY #0483

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Laboratory Demographics

CLIA Number: 42D0991908

Facility Name: PUBLIX PHARMACY #0483

Facility Address:
1575 OLD TROLLEY ROAD
SUMMERVILLE, SC
ZIP 29485
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Facility Phone Number: 843 832-0557

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1629017538

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	42D0991908
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #0483
Street	1575 OLD TROLLEY ROAD
City	SUMMERVILLE
State	SC
ZIP	29485
Phone	843 832-0557
CertificateType	4
CertificateEffectiveDate	3/16/2023
CertificateExpirationDate	3/15/2025
FacilityType	Waiver

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