04D2182819 CLIA NUMBER - FREEDOM PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 04D2182819
  • Facility Name: FREEDOM PHARMACY LLC
  • Facility Address: 710 4TH STREET
    MENA, AR
    ZIP 71953
  • Facility Phone: 479 437-3089
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RICKY J. WIRT
  • NPI Number: 1316251432
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2182819
LAB Type Pharmacy
Facility Name FREEDOM PHARMACY LLC
Street 710 4TH STREET
City MENA
State AR
ZIP 71953
Phone 479 437-3089
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2024
Certificate Expiration Date 4/26/2026
Facility Type Pharmacy
Lab Director RICKY J. WIRT

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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