04D1021888 CLIA NUMBER - KROGER PHARMACY #639

Laboratory Demographics

CLIA Number: 04D1021888

Facility Name: KROGER PHARMACY #639

Facility Address:
2509 MCCAIN BLVD
NORTH LITTLE ROCK, AR
ZIP 72116
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Facility Phone Number: 501 758-9307

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1053345801

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	04D1021888
LAB Type	Pharmacy
Facility Name	KROGER PHARMACY #639
Street	2509 MCCAIN BLVD
City	NORTH LITTLE ROCK
State	AR
ZIP	72116
Phone	501 758-9307
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