04D2184661 CLIA NUMBER - COMMUNITY PHARMACY OF SPRINGDALE MCKINNEY DRUG STORE

Laboratory Demographics

  • CLIA Code: 04D2184661
  • Facility Name: COMMUNITY PHARMACY OF SPRINGDALE MCKINNEY DRUG STORE
  • Facility Address: 400 W EMMA AVENUE
    SPRINGDALE, AR
    ZIP 72764
  • Facility Phone: 479 750-2220
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VICTORIA L. HENNESSEY
  • NPI Number: 1023445293
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2184661
LAB Type Pharmacy
Facility Name COMMUNITY PHARMACY OF SPRINGDALE MCKINNEY DRUG STORE
Street 400 W EMMA AVENUE
City SPRINGDALE
State AR
ZIP 72764
Phone 479 750-2220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/22/2024
Certificate Expiration Date 5/21/2026
Facility Type Pharmacy
Lab Director VICTORIA L. HENNESSEY

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