04D2157281 CLIA NUMBER - KAVANAUGH PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2157281
  • Facility Name: KAVANAUGH PHARMACY
  • Facility Address: 5200 KAVANAUGH BLVD
    LITTLE ROCK, AR
    ZIP 72207
  • Facility Phone: 501 664-3844
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANNE C. PACE
  • NPI Number: 1093858698
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2157281
LAB Type Pharmacy
Facility Name KAVANAUGH PHARMACY
Street 5200 KAVANAUGH BLVD
City LITTLE ROCK
State AR
ZIP 72207
Phone 501 664-3844
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2024
Certificate Expiration Date 11/1/2026
Facility Type Pharmacy
Lab Director ANNE C. PACE

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