18D2194194 CLIA NUMBER - UPPER LEVISA CLINIC PHARMACY

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Laboratory Demographics

CLIA Number: 18D2194194

Facility Name: UPPER LEVISA CLINIC PHARMACY

Facility Address:
137 N LEVISA RD
MOUTHCARD, KY
ZIP 41548
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Facility Phone Number: 606 598-8831

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376648659

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	18D2194194
LAB Type	Pharmacy
Facility Name	UPPER LEVISA CLINIC PHARMACY
Street	137 N LEVISA RD
City	MOUTHCARD
State	KY
ZIP	41548
Phone	606 598-8831
CertificateType	4
CertificateEffectiveDate	9/29/2022
CertificateExpirationDate	9/28/2024
FacilityType	Waiver

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