04D2006362 CLIA NUMBER - KROGER PHARMACY 582

Laboratory Demographics

  • CLIA Code: 04D2006362
  • Facility Name: KROGER PHARMACY 582
  • Facility Address: 10300 RODNEY PARHAM ROAD
    LITTLE ROCK, AR
    ZIP 72207
  • Facility Phone: 501 221-8301
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1083774210
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2006362
LAB Type Pharmacy
Facility Name KROGER PHARMACY 582
Street 10300 RODNEY PARHAM ROAD
City LITTLE ROCK
State AR
ZIP 72207
Phone 501 221-8301
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/20/2024
Certificate Expiration Date 4/19/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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