04D2154517 CLIA NUMBER - SOUTHERN PHARMACY OF ARKANSAS

Laboratory Demographics

CLIA Number: 04D2154517

Facility Name: SOUTHERN PHARMACY OF ARKANSAS

Facility Address:
3001 APACHE DRIVE
JONESBORO, AR
ZIP 72401
Get Directions

Facility Phone Number: 870 972-1751

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1003302761

Taxonomy: 1223G0001X - Dentist
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

CLIA Record

Field Name	Field Value
CLIA Number	04D2154517
LAB Type	Pharmacy
Facility Name	SOUTHERN PHARMACY OF ARKANSAS
Street	3001 APACHE DRIVE
City	JONESBORO
State	AR
ZIP	72401
Phone	870 972-1751
CertificateType	4
CertificateEffectiveDate	9/14/2022
CertificateExpirationDate	9/13/2024
FacilityType	Waiver

Download Record

Export to text format icon Download this CLIA NUMBER record in Text format: Export

Export to text format icon Download this CLIA NUMBER record in Excel (CSV) format: Export

Export to text format icon Download this CLIA NUMBER record in XML format: Export

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