04D2122276 CLIA NUMBER - KROGER PHARMACY #409

Laboratory Demographics

  • CLIA Code: 04D2122276
  • Facility Name: KROGER PHARMACY #409
  • Facility Address: 1725 SOUTH CARAWAY RD
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 972-4739
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CYNTHIA B. FISHER
  • NPI Number: 1235163080
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2122276
LAB Type Pharmacy
Facility Name KROGER PHARMACY #409
Street 1725 SOUTH CARAWAY RD
City JONESBORO
State AR
ZIP 72401
Phone 870 972-4739
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2024
Certificate Expiration Date 11/22/2026
Facility Type Pharmacy
Lab Director CYNTHIA B. FISHER

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