44D2154750 CLIA NUMBER - PUBLIX PHARMACY #1613

Laboratory Demographics

CLIA Number: 44D2154750

Facility Name: PUBLIX PHARMACY #1613

Facility Address:
1600 N JACKSON STREET SUITE 340
TULLAHOMA, TN
ZIP 37388
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Facility Phone Number: 863 688-1188

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1588141899

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	44D2154750
LAB Type	Pharmacy
Facility Name	PUBLIX PHARMACY #1613
Street	1600 N JACKSON STREET SUITE 340
City	TULLAHOMA
State	TN
ZIP	37388
Phone	863 688-1188
CertificateType	4
CertificateEffectiveDate	9/18/2022
CertificateExpirationDate	9/17/2024
FacilityType	Waiver

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