18D2041779 CLIA NUMBER - WALGREENS #6104

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Laboratory Demographics

CLIA Number: 18D2041779

Facility Name: WALGREENS #6104

Facility Address:
2901 FORT CAMPBELL BLVD
HOPKINSVILLE, KY
ZIP 42240
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Facility Phone Number: 270 886-0128

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1134134372

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	18D2041779
LAB Type	Pharmacy
Facility Name	WALGREENS #6104
Street	2901 FORT CAMPBELL BLVD
City	HOPKINSVILLE
State	KY
ZIP	42240
Phone	270 886-0128
CertificateType	4
CertificateEffectiveDate	3/27/2023
CertificateExpirationDate	3/26/2025
FacilityType	Waiver

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