45D2175808 CLIA NUMBER - GIBSON PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 45D2175808
  • Facility Name: GIBSON PHARMACY LLC
  • Facility Address: 600 S PALESTINE ST, STE 100
    ATHENS, TX
    ZIP 75751
  • Facility Phone: 903 675-7069
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LISA M. KOCIAN
  • NPI Number: 1821578865
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 45D2175808
LAB Type Pharmacy
Facility Name GIBSON PHARMACY LLC
Street 600 S PALESTINE ST, STE 100
City ATHENS
State TX
ZIP 75751
Phone 903 675-7069
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/2/2023
Certificate Expiration Date 12/1/2025
Facility Type Pharmacy
Lab Director LISA M. KOCIAN

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