51D1048579 CLIA NUMBER - FRUTH PHARMACY #23

Laboratory Demographics

CLIA Number: 51D1048579

Facility Name: FRUTH PHARMACY #23

Facility Address:
4012 TEAYS VALLEY ROAD
SCOTT DEPOT, WV
ZIP 25560
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Facility Phone Number: 304 201-1630

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1427063361

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	51D1048579
LAB Type	Pharmacy
Facility Name	FRUTH PHARMACY #23
Street	4012 TEAYS VALLEY ROAD
City	SCOTT DEPOT
State	WV
ZIP	25560
Phone	304 201-1630
CertificateType	4
CertificateEffectiveDate	12/6/2023
CertificateExpirationDate	12/5/2025
FacilityType	Waiver

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