45D2249457 CLIA NUMBER - TOM THUMB PHARMACY #1786

Laboratory Demographics

CLIA Number: 45D2249457

Facility Name: TOM THUMB PHARMACY #1786

Facility Address:
4215 S CARRIER PKWY
GRAND PRAIRIE, TX
ZIP 75052
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Facility Phone Number: 972 266-7056

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1134158199

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	45D2249457
LAB Type	Pharmacy
Facility Name	TOM THUMB PHARMACY #1786
Street	4215 S CARRIER PKWY
City	GRAND PRAIRIE
State	TX
ZIP	75052
Phone	972 266-7056
CertificateType	4
CertificateEffectiveDate	1/20/2024
CertificateExpirationDate	1/19/2026
FacilityType	Waiver

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