42D2092776 CLIA NUMBER - PUBLIX PHARMACY #1479

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Laboratory Demographics

CLIA Number: 42D2092776

Facility Name: PUBLIX PHARMACY #1479

Facility Address:
1576 HIGHWAY 17 NORTH
NORTH MYRTLE BEACH, SC
ZIP 29582
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Facility Phone Number: 843 272-0059

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1821493693

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	42D2092776
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1479
Street	1576 HIGHWAY 17 NORTH
City	NORTH MYRTLE BEACH
State	SC
ZIP	29582
Phone	843 272-0059
CertificateType	4
CertificateEffectiveDate	3/12/2023
CertificateExpirationDate	3/11/2025
FacilityType	Waiver

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