18D2171738 CLIA NUMBER - GIBSON'S PHARMACY SOUTHSIDE

Laboratory Demographics

  • CLIA Code: 18D2171738
  • Facility Name: GIBSON'S PHARMACY SOUTHSIDE
  • Facility Address: 1206 PARIS RD
    MAYFIELD, KY
    ZIP 42066
  • Facility Phone: 270 247-1055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. SAMUEL S. BROWN
  • NPI Number: 1316306624
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2171738
LAB Type Pharmacy
Facility Name GIBSON'S PHARMACY SOUTHSIDE
Street 1206 PARIS RD
City MAYFIELD
State KY
ZIP 42066
Phone 270 247-1055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/9/2025
Certificate Expiration Date 9/8/2027
Facility Type Pharmacy
Lab Director MR. SAMUEL S. BROWN

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