18D1082558 CLIA NUMBER - CLINIC PHARMACY

Laboratory Demographics

CLIA Number: 18D1082558

Facility Name: CLINIC PHARMACY

Facility Address:
201 PARK STREET
BOWLING GREEN, KY
ZIP 42101
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Facility Phone Number: 270 781-3095

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1356412787

Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies
A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

CLIA Record

Field Name	Field Value
CLIA Number	18D1082558
LAB Type	Pharmacy
Facility Name	CLINIC PHARMACY
Street	201 PARK STREET
City	BOWLING GREEN
State	KY
ZIP	42101
Phone	270 781-3095
CertificateType	4
CertificateEffectiveDate	4/14/2024
CertificateExpirationDate	4/13/2026
FacilityType	Waiver

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