49D1061142 CLIA NUMBER - MAIN STREET PHARMACY

Laboratory Demographics

CLIA Number: 49D1061142

Facility Name: MAIN STREET PHARMACY

Facility Address:
308 N MAIN STREET
KILMARNOCK, VA
ZIP 22482
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Facility Phone Number: 804 435-8818

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1528016771

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	49D1061142
LAB Type	Pharmacy
Facility Name	MAIN STREET PHARMACY
Street	308 N MAIN STREET
City	KILMARNOCK
State	VA
ZIP	22482
Phone	804 435-8818
CertificateType	4
CertificateEffectiveDate	11/9/2022
CertificateExpirationDate	11/8/2024
FacilityType	Waiver

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