44D2205923 CLIA NUMBER - LIFE WELL PHARMACY DBA LIFEWELL HEALTH SERVICES

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Laboratory Demographics

CLIA Number: 44D2205923

Facility Name: LIFE WELL PHARMACY DBA LIFEWELL HEALTH SERVICES

Facility Address:
2408 SUSANNAH ST STE 3
JOHNSON CITY, TN
ZIP 37601
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Facility Phone Number: 423 202-7870

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1366065278

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	44D2205923
LAB Type	Pharmacy
Facility Name	LIFE WELL PHARMACY DBA LIFEWELL HEALTH SERVICES
Street	2408 SUSANNAH ST STE 3
City	JOHNSON CITY
State	TN
ZIP	37601
Phone	423 202-7870
CertificateType	4
CertificateEffectiveDate	12/16/2022
CertificateExpirationDate	12/15/2024
FacilityType	Waiver

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