18D2183983 CLIA NUMBER - ST MATTHEWS SPECIALTY PHARMACY

Laboratory Demographics

  • CLIA Code: 18D2183983
  • Facility Name: ST MATTHEWS SPECIALTY PHARMACY
  • Facility Address: 200 N HURSTBOURNE PKWY, SUITE 176
    LOUISVILLE, KY
    ZIP 40222
  • Facility Phone: 844 690-4462
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. PATRICK SOUTHALL
  • NPI Number: 1437811734
  • Taxonomy: 332B00000X - Durable Medical Equipment & Medical Supplies

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CLIA Record

Field Name Field Value
CLIA Number 18D2183983
LAB Type Pharmacy
Facility Name ST MATTHEWS SPECIALTY PHARMACY
Street 200 N HURSTBOURNE PKWY, SUITE 176
City LOUISVILLE
State KY
ZIP 40222
Phone 844 690-4462
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/13/2024
Certificate Expiration Date 5/12/2026
Facility Type Pharmacy
Lab Director MS. PATRICK SOUTHALL

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