04D2157281 CLIA NUMBER - KAVANAUGH PHARMACY

Laboratory Demographics

CLIA Number: 04D2157281

Facility Name: KAVANAUGH PHARMACY

Facility Address:
5200 KAVANAUGH BLVD
LITTLE ROCK, AR
ZIP 72207
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Facility Phone Number: 501 664-3844

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1093858698

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

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
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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