45D2042740 CLIA NUMBER - BROOKSHIRES PHARMACY #58

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Laboratory Demographics

CLIA Number: 45D2042740

Facility Name: BROOKSHIRES PHARMACY #58

Facility Address:
306 STATE HWY 37 SOUTH, BOX 513
MOUNT VERNON, TX
ZIP 75457
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Facility Phone Number: 903 537-2886

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1609949932

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	45D2042740
LAB Type	Pharmacy
Facility Name	BROOKSHIRES PHARMACY #58
Street	306 STATE HWY 37 SOUTH, BOX 513
City	MOUNT VERNON
State	TX
ZIP	75457
Phone	903 537-2886
CertificateType	4
CertificateEffectiveDate	6/19/2022
CertificateExpirationDate	6/18/2024
FacilityType	Waiver

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