04D1021883 CLIA NUMBER - KROGER PHARMACY 652

Laboratory Demographics

  • CLIA Code: 04D1021883
  • Facility Name: KROGER PHARMACY 652
  • Facility Address: 101 WEST OAK STREET
    CONWAY, AR
    ZIP 72032
  • Facility Phone: 501 329-0795
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1174683304
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D1021883
LAB Type Pharmacy
Facility Name KROGER PHARMACY 652
Street 101 WEST OAK STREET
City CONWAY
State AR
ZIP 72032
Phone 501 329-0795
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