04D2154320 CLIA NUMBER - AMITY ROAD PHARMACY

Laboratory Demographics

CLIA Number: 04D2154320

Facility Name: AMITY ROAD PHARMACY

Facility Address:
810 AMITY RD, SUITE 101
CONWAY, AR
ZIP 72032
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Facility Phone Number: 501 358-3863

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1821335845

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	04D2154320
LAB Type	Pharmacy
Facility Name	AMITY ROAD PHARMACY
Street	810 AMITY RD, SUITE 101
City	CONWAY
State	AR
ZIP	72032
Phone	501 358-3863
CertificateType	4
CertificateEffectiveDate	9/11/2022
CertificateExpirationDate	9/10/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024