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04D1021875 CLIA NUMBER - KROGER PHARMACY #623

Laboratory Demographics

CLIA Number: 04D1021875

Facility Name: KROGER PHARMACY #623

Facility Address:
16105 B CHENAL PARKWAY
LITTLE ROCK, AR
ZIP 72223
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Facility Phone Number: 501 821-6841

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1003831702

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 04D1021875
LAB Type Pharmacy
Facility Name KROGER PHARMACY #623
Street 16105 B CHENAL PARKWAY
City LITTLE ROCK
State AR
ZIP 72223
Phone 501 821-6841
CertificateType 4
CertificateEffectiveDate 2/3/2024
CertificateExpirationDate 2/2/2026
FacilityType Waiver

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