04D2183796 CLIA NUMBER - HEARTLAND PHARMACY FAYETTEVILLE

Laboratory Demographics

  • CLIA Code: 04D2183796
  • Facility Name: HEARTLAND PHARMACY FAYETTEVILLE
  • Facility Address: 1450 E ZION RD, SUITE 1
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 444-7200
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS C. COOPER
  • NPI Number: 1689113136
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2183796
LAB Type Pharmacy
Facility Name HEARTLAND PHARMACY FAYETTEVILLE
Street 1450 E ZION RD, SUITE 1
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 444-7200
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/11/2024
Certificate Expiration Date 5/10/2026
Facility Type Pharmacy
Lab Director CHRIS C. COOPER

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