04D2184999 CLIA NUMBER - MEDICINE MAN PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2184999
  • Facility Name: MEDICINE MAN PHARMACY
  • Facility Address: 2520 MAIN STREET
    NORTH LITTLE ROCK, AR
    ZIP 72114
  • Facility Phone: 501 758-7581
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TERRY PERKINS
  • NPI Number: 1467506923
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2184999
LAB Type Pharmacy
Facility Name MEDICINE MAN PHARMACY
Street 2520 MAIN STREET
City NORTH LITTLE ROCK
State AR
ZIP 72114
Phone 501 758-7581
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/2024
Certificate Expiration Date 5/27/2026
Facility Type Pharmacy
Lab Director TERRY PERKINS

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