42D1021641 CLIA NUMBER - SWEETGRASS PEDIATRICS

Laboratory Demographics

CLIA Number: 42D1021641

Facility Name: SWEETGRASS PEDIATRICS

Facility Address:
1115 PROFESSIONAL LANE
MT PLEASANT, SC
ZIP 29466
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Facility Phone Number: 843 432-3113

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1720689276

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	42D1021641
LAB Type	Physician Office
Facility Name	SWEETGRASS PEDIATRICS
Street	1115 PROFESSIONAL LANE
City	MT PLEASANT
State	SC
ZIP	29466
Phone	843 432-3113
CertificateType	4
CertificateEffectiveDate	7/15/2022
CertificateExpirationDate	7/14/2024
FacilityType	Waiver

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