51D2109315 CLIA NUMBER - FRUTH PHARMACY AT PRESTERA CENTER # 104

Laboratory Demographics

CLIA Number: 51D2109315

Facility Name: FRUTH PHARMACY AT PRESTERA CENTER # 104

Facility Address:
511 MORRIS STREET
CHARLESTON, WV
ZIP 25301
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Facility Phone Number: 304 341-0257

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1629078118

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	51D2109315
LAB Type	Pharmacy
Facility Name	FRUTH PHARMACY AT PRESTERA CENTER # 104
Street	511 MORRIS STREET
City	CHARLESTON
State	WV
ZIP	25301
Phone	304 341-0257
CertificateType	4
CertificateEffectiveDate	2/23/2024
CertificateExpirationDate	2/22/2026
FacilityType	Waiver

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