45D2209723 CLIA NUMBER - FIESTA LIFECARE PHARMACY 5, LLC

Home > CLIA Lookup > 45D2209723

Laboratory Demographics

CLIA Number: 45D2209723

Facility Name: FIESTA LIFECARE PHARMACY 5, LLC

Facility Address:
3230 MARTIN LUTHER KING JR BLVD PHARMACY DEPT
DALLAS, TX
ZIP 75210
Get Directions

Facility Phone Number: 214 421-1067

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1104377332

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	45D2209723
LAB Type	Pharmacy
Facility Name	FIESTA LIFECARE PHARMACY 5, LLC
Street	3230 MARTIN LUTHER KING JR BLVD PHARMACY DEPT
City	DALLAS
State	TX
ZIP	75210
Phone	214 421-1067
CertificateType	4
CertificateEffectiveDate	1/15/2023
CertificateExpirationDate	1/14/2025
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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