04D1026372 CLIA NUMBER - KROGER PHARMACY 613

Laboratory Demographics

  • CLIA Code: 04D1026372
  • Facility Name: KROGER PHARMACY 613
  • Facility Address: 1295 WEST MAIN STREET
    CABOT, AR
    ZIP 72023
  • Facility Phone: 501 628-3787
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1134153984
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D1026372
LAB Type Pharmacy
Facility Name KROGER PHARMACY 613
Street 1295 WEST MAIN STREET
City CABOT
State AR
ZIP 72023
Phone 501 628-3787
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2024
Certificate Expiration Date 6/2/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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This page was last updated on: 9/29/2025