04D2182819 CLIA NUMBER - FREEDOM PHARMACY LLC

Laboratory Demographics

CLIA Number: 04D2182819

Facility Name: FREEDOM PHARMACY LLC

Facility Address:
710 4TH STREET
MENA, AR
ZIP 71953
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Facility Phone Number: 479 437-3089

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1316251432

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	04D2182819
LAB Type	Pharmacy
Facility Name	FREEDOM PHARMACY LLC
Street	710 4TH STREET
City	MENA
State	AR
ZIP	71953
Phone	479 437-3089
CertificateType	4
CertificateEffectiveDate	4/27/2024
CertificateExpirationDate	4/26/2026
FacilityType	Waiver

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