18D2062191 CLIA NUMBER - BLUEGRASS PHARMACY

Laboratory Demographics

  • CLIA Code: 18D2062191
  • Facility Name: BLUEGRASS PHARMACY
  • Facility Address: 1128 NORTH MAIN STREET, SUITE 1
    MADISONVILLE, KY
    ZIP 42431
  • Facility Phone: (270) 825-2775
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: GARY S. RUSSELL
  • NPI Number: 1225106057
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2062191
LAB Type Pharmacy
Facility Name BLUEGRASS PHARMACY
Street 1128 NORTH MAIN STREET, SUITE 1
City MADISONVILLE
State KY
ZIP 42431
Phone 2708252775
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/11/2025
Certificate Expiration Date 7/10/2027
Facility Type Pharmacy
Lab Director GARY S. RUSSELL

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This page was last updated on: 5/18/2026