01D2098979 CLIA NUMBER - EASTSIDE PHARMACY AND CUSTOM COMPOUNDING INC

Laboratory Demographics

  • CLIA Code: 01D2098979
  • Facility Name: EASTSIDE PHARMACY AND CUSTOM COMPOUNDING INC
  • Facility Address: 1406 LINDSAY LANE SOUTH, SUITE A
    ATHENS, AL
    ZIP 35613
  • Facility Phone: 256 233-7070
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MONIQUE D. CANNON
  • NPI Number: 1881884161
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2098979
LAB Type Pharmacy
Facility Name EASTSIDE PHARMACY AND CUSTOM COMPOUNDING INC
Street 1406 LINDSAY LANE SOUTH, SUITE A
City ATHENS
State AL
ZIP 35613
Phone 256 233-7070
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director MONIQUE D. CANNON

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This page was last updated on: 9/29/2025