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42D2164254 CLIA NUMBER - TIDEWATER HEALTH

Laboratory Demographics

CLIA Number: 42D2164254

Facility Name: TIDEWATER HEALTH

Facility Address:
1435 STUART ENGALS BLVD SUITE101
MOUNT PLEASANT, SC
ZIP 29464
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Facility Phone Number: 843 800-5686

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1639562945

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 42D2164254
LAB Type Physician Office
Facility Name TIDEWATER HEALTH
Street 1435 STUART ENGALS BLVD SUITE101
City MOUNT PLEASANT
State SC
ZIP 29464
Phone 843 800-5686
CertificateType 4
CertificateEffectiveDate 4/1/2023
CertificateExpirationDate 3/31/2025
FacilityType Waiver

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