49D2199435 CLIA NUMBER - VAN DORN PHARMACY

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Laboratory Demographics

CLIA Number: 49D2199435

Facility Name: VAN DORN PHARMACY

Facility Address:
5724 EDSALL RD
ALEXANDRIA, VA
ZIP 22304
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Facility Phone Number: 703 348-7186

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1174151716

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	49D2199435
LAB Type	Pharmacy
Facility Name	VAN DORN PHARMACY
Street	5724 EDSALL RD
City	ALEXANDRIA
State	VA
ZIP	22304
Phone	703 348-7186
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