45D2154467 CLIA NUMBER - MEDICAL PLAZA PHARMACY

Laboratory Demographics

CLIA Number: 45D2154467

Facility Name: MEDICAL PLAZA PHARMACY

Facility Address:
615 NORTH THIRD, SUITE 1
LONGVIEW, TX
ZIP 75601
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Facility Phone Number: 903 234-8329

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1598709800

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 45D2154467
LAB Type Pharmacy
Facility Name MEDICAL PLAZA PHARMACY
Street 615 NORTH THIRD, SUITE 1
City LONGVIEW
State TX
ZIP 75601
Phone 903 234-8329
CertificateType 4
CertificateEffectiveDate 9/13/2022
CertificateExpirationDate 9/12/2024
FacilityType Waiver

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