04D1021885 CLIA NUMBER - KROGER PHARMACY 638

Laboratory Demographics

  • CLIA Code: 04D1021885
  • Facility Name: KROGER PHARMACY 638
  • Facility Address: 4401 CAMP ROBINSON ROAD
    NORTH LITTLE ROCK, AR
    ZIP 72118
  • Facility Phone: 501 758-6380
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1881628626
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D1021885
LAB Type Pharmacy
Facility Name KROGER PHARMACY 638
Street 4401 CAMP ROBINSON ROAD
City NORTH LITTLE ROCK
State AR
ZIP 72118
Phone 501 758-6380
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