04D2188877 CLIA NUMBER - CORNERSTONE PHARMACY ROSE CITY

Laboratory Demographics

  • CLIA Code: 04D2188877
  • Facility Name: CORNERSTONE PHARMACY ROSE CITY
  • Facility Address: 4307 E BROADWAY
    NORTH LITTLE ROCK, AR
    ZIP 72117
  • Facility Phone: 501 945-3264
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RANDY I. KASSISSIEH
  • NPI Number: 1699789545
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2188877
LAB Type Pharmacy
Facility Name CORNERSTONE PHARMACY ROSE CITY
Street 4307 E BROADWAY
City NORTH LITTLE ROCK
State AR
ZIP 72117
Phone 501 945-3264
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/23/2024
Certificate Expiration Date 7/22/2026
Facility Type Pharmacy
Lab Director RANDY I. KASSISSIEH

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