04D2137064 CLIA NUMBER - SOO'S WEST END PHARMACY WEST END ASSOCIATES, INC

Laboratory Demographics

  • CLIA Code: 04D2137064
  • Facility Name: SOO'S WEST END PHARMACY WEST END ASSOCIATES, INC
  • Facility Address: 619 W NETTLETON AVENUE
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 932-4742
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY D. MOONEYHAM
  • NPI Number: 1831536283
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2137064
LAB Type Pharmacy
Facility Name SOO'S WEST END PHARMACY WEST END ASSOCIATES, INC
Street 619 W NETTLETON AVENUE
City JONESBORO
State AR
ZIP 72401
Phone 870 932-4742
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/19/2025
Certificate Expiration Date 9/18/2027
Facility Type Pharmacy
Lab Director TRACY D. MOONEYHAM

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