18D2168251 CLIA NUMBER - PINE MOUNTAIN PHARMACY, INC

Laboratory Demographics

  • CLIA Code: 18D2168251
  • Facility Name: PINE MOUNTAIN PHARMACY, INC
  • Facility Address: 421 WHY 119 N
    WHITESBURG, KY
    ZIP 41858
  • Facility Phone: 606 633-5003
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. AMY J. CASEBOLT
  • NPI Number: 1144799719
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2168251
LAB Type Pharmacy
Facility Name PINE MOUNTAIN PHARMACY, INC
Street 421 WHY 119 N
City WHITESBURG
State KY
ZIP 41858
Phone 606 633-5003
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/25/2025
Certificate Expiration Date 6/24/2027
Facility Type Pharmacy
Lab Director MS. AMY J. CASEBOLT

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This page was last updated on: 9/29/2025