18D2296964 CLIA NUMBER - FOUNTAIN SQUARE PHARMACY

Laboratory Demographics

  • CLIA Code: 18D2296964
  • Facility Name: FOUNTAIN SQUARE PHARMACY
  • Facility Address: 1928 W CUMBERLAND AVE
    MIDDLESBORO, KY
    ZIP 40965
  • Facility Phone: 606 248-4444
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. MAURICE A. MCGLONE
  • NPI Number: 1700885001
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 18D2296964
LAB Type Pharmacy
Facility Name FOUNTAIN SQUARE PHARMACY
Street 1928 W CUMBERLAND AVE
City MIDDLESBORO
State KY
ZIP 40965
Phone 606 248-4444
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/9/2024
Certificate Expiration Date 1/8/2026
Facility Type Pharmacy
Lab Director MR. MAURICE A. MCGLONE

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