04D1021878 CLIA NUMBER - KROGER PHARMACY 687

Laboratory Demographics

  • CLIA Code: 04D1021878
  • Facility Name: KROGER PHARMACY 687
  • Facility Address: 303 ST LOUIS STREET
    BATESVILLE, AR
    ZIP 72501
  • Facility Phone: 870 793-3000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1265592497
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D1021878
LAB Type Pharmacy
Facility Name KROGER PHARMACY 687
Street 303 ST LOUIS STREET
City BATESVILLE
State AR
ZIP 72501
Phone 870 793-3000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2024
Certificate Expiration Date 2/2/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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