18D2074673 CLIA NUMBER - ST MATTHEWS COMMUNITY PHARMACY

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Laboratory Demographics

CLIA Number: 18D2074673

Facility Name: ST MATTHEWS COMMUNITY PHARMACY

Facility Address:
200 N HURSTBOURNE PKWY, SUITE 174
LOUISVILLE, KY
ZIP 40222
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Facility Phone Number: 502 690-4462

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1699319814

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	18D2074673
LAB Type	Pharmacy
Facility Name	ST MATTHEWS COMMUNITY PHARMACY
Street	200 N HURSTBOURNE PKWY, SUITE 174
City	LOUISVILLE
State	KY
ZIP	40222
Phone	502 690-4462
CertificateType	4
CertificateEffectiveDate	3/13/2024
CertificateExpirationDate	3/12/2026
FacilityType	Waiver

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