18D2175589 CLIA NUMBER - BUSHONG FAMILY PHARMACY, LLC

Laboratory Demographics

CLIA Number: 18D2175589

Facility Name: BUSHONG FAMILY PHARMACY, LLC

Facility Address:
709 N MAIN ST
TOMPKINSVILLE, KY
ZIP 42167
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Facility Phone Number: 270 407-5045

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1023564747

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	18D2175589
LAB Type	Pharmacy
Facility Name	BUSHONG FAMILY PHARMACY, LLC
Street	709 N MAIN ST
City	TOMPKINSVILLE
State	KY
ZIP	42167
Phone	270 407-5045
CertificateType	4
CertificateEffectiveDate	11/25/2023
CertificateExpirationDate	11/24/2025
FacilityType	Waiver

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