04D2154375 CLIA NUMBER - ICARERX PHARMACY RX HOUND, INC

Laboratory Demographics

  • CLIA Code: 04D2154375
  • Facility Name: ICARERX PHARMACY RX HOUND, INC
  • Facility Address: 1117 MCLAIN, STE 400
    NEWPORT, AR
    ZIP 72112
  • Facility Phone: 870 523-5555
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM E. SHOFFNER
  • NPI Number: 1780120691
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2154375
LAB Type Pharmacy
Facility Name ICARERX PHARMACY RX HOUND, INC
Street 1117 MCLAIN, STE 400
City NEWPORT
State AR
ZIP 72112
Phone 870 523-5555
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/11/2024
Certificate Expiration Date 9/10/2026
Facility Type Pharmacy
Lab Director WILLIAM E. SHOFFNER

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