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04D1021883 CLIA NUMBER - KROGER PHARMACY 652

Laboratory Demographics

CLIA Number: 04D1021883

Facility Name: KROGER PHARMACY 652

Facility Address:
101 WEST OAK STREET
CONWAY, AR
ZIP 72032
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Facility Phone Number: 501 329-0795

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1174683304

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