01D2187485 CLIA NUMBER - CRESTLINE PHARMACY

Laboratory Demographics

  • CLIA Code: 01D2187485
  • Facility Name: CRESTLINE PHARMACY
  • Facility Address: 60 CHURCH STREET
    MOUNTAIN BROOK, AL
    ZIP 35213
  • Facility Phone: 205 871-0317
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW LEACH
  • NPI Number: 1659446458
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2187485
LAB Type Pharmacy
Facility Name CRESTLINE PHARMACY
Street 60 CHURCH STREET
City MOUNTAIN BROOK
State AL
ZIP 35213
Phone 205 871-0317
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/2/2024
Certificate Expiration Date 7/1/2026
Facility Type Pharmacy
Lab Director MATTHEW LEACH

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