04D1021878 CLIA NUMBER - KROGER PHARMACY 687

Laboratory Demographics

CLIA Number: 04D1021878

Facility Name: KROGER PHARMACY 687

Facility Address:
303 ST LOUIS STREET
BATESVILLE, AR
ZIP 72501
Get Directions

Facility Phone Number: 870 793-3000

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1265592497

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	04D1021878
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY 687
Street	303 ST LOUIS STREET
City	BATESVILLE
State	AR
ZIP	72501
Phone	870 793-3000
CertificateType	4
CertificateEffectiveDate	2/3/2024
CertificateExpirationDate	2/2/2026
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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