01D2187485 CLIA NUMBER - CRESTLINE PHARMACY

Laboratory Demographics

CLIA Number: 01D2187485

Facility Name: CRESTLINE PHARMACY

Facility Address:
60 CHURCH STREET
MOUNTAIN BROOK, AL
ZIP 35213
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Facility Phone Number: 205 871-0317

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1659446458

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

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
CertificateType	4
CertificateEffectiveDate	7/2/2022
CertificateExpirationDate	7/1/2024
FacilityType	Waiver

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