18D2212352 CLIA NUMBER - GRASSROOTS PHARMACY

Laboratory Demographics

CLIA Number: 18D2212352

Facility Name: GRASSROOTS PHARMACY

Facility Address:
2304 SIR BARTON WAY SUITE 195
LEXINGTON, KY
ZIP 40509
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Facility Phone Number: 859 263-1382

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336690122

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	18D2212352
LAB Type	Pharmacy
Facility Name	GRASSROOTS PHARMACY
Street	2304 SIR BARTON WAY SUITE 195
City	LEXINGTON
State	KY
ZIP	40509
Phone	859 263-1382
CertificateType	4
CertificateEffectiveDate	2/4/2023
CertificateExpirationDate	2/3/2025
FacilityType	Waiver

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