04D2189403 CLIA NUMBER - DEAN'S PHARMACY #3

Laboratory Demographics

  • CLIA Code: 04D2189403
  • Facility Name: DEAN'S PHARMACY #3
  • Facility Address: 311 W CHESTNUT STREET
    MARIANNA, AR
    ZIP 72360
  • Facility Phone: 870 295-4100
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACQUE CHARLES
  • NPI Number: 1396984498
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2189403
LAB Type Pharmacy
Facility Name DEAN'S PHARMACY #3
Street 311 W CHESTNUT STREET
City MARIANNA
State AR
ZIP 72360
Phone 870 295-4100
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2024
Certificate Expiration Date 7/29/2026
Facility Type Pharmacy
Lab Director JACQUE CHARLES

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