04D2144468 CLIA NUMBER - EXPRESS RX OF OTTER CREEK

Laboratory Demographics

  • CLIA Code: 04D2144468
  • Facility Name: EXPRESS RX OF OTTER CREEK
  • Facility Address: 10100 STAGECOACH RD
    LITTLE ROCK, AR
    ZIP 72210
  • Facility Phone: 501 455-2522
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC CRUMBAUGH
  • NPI Number: 1285167502
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2144468
LAB Type Pharmacy
Facility Name EXPRESS RX OF OTTER CREEK
Street 10100 STAGECOACH RD
City LITTLE ROCK
State AR
ZIP 72210
Phone 501 455-2522
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/3/2024
Certificate Expiration Date 4/2/2026
Facility Type Pharmacy
Lab Director ERIC CRUMBAUGH

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