04D2036380 CLIA NUMBER - ALBERTSONS PHARMACY #0611

Laboratory Demographics

  • CLIA Code: 04D2036380
  • Facility Name: ALBERTSONS PHARMACY #0611
  • Facility Address: 3710 N STATE LINE AVE
    TEXARKANA, AR
    ZIP 71854
  • Facility Phone: 870 773-5521
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HARI P. RAMINENI
  • NPI Number: 1013956499
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2036380
LAB Type Pharmacy
Facility Name ALBERTSONS PHARMACY #0611
Street 3710 N STATE LINE AVE
City TEXARKANA
State AR
ZIP 71854
Phone 870 773-5521
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2024
Certificate Expiration Date 2/6/2026
Facility Type Pharmacy
Lab Director HARI P. RAMINENI

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