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04D1021880 CLIA NUMBER - KROGER PHARMACY #465

Laboratory Demographics

CLIA Number: 04D1021880

Facility Name: KROGER PHARMACY #465

Facility Address:
400 WEST MOULTRIE
BLYTHEVILLE, AR
ZIP 72315
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Facility Phone Number: 870 763-7951

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1407880255

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 04D1021880
LAB Type Pharmacy
Facility Name KROGER PHARMACY #465
Street 400 WEST MOULTRIE
City BLYTHEVILLE
State AR
ZIP 72315
Phone 870 763-7951
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