04D2189780 CLIA NUMBER - FREIDERICA PHARMACY AND COMPOUNDING

Laboratory Demographics

  • CLIA Code: 04D2189780
  • Facility Name: FREIDERICA PHARMACY AND COMPOUNDING
  • Facility Address: 400 W CAPITOL, SUITE 101A
    LITTLE ROCK, AR
    ZIP 72201
  • Facility Phone: 501 374-2207
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. WALTER L. FRUCHEY
  • NPI Number: 1255449831
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2189780
LAB Type Pharmacy
Facility Name FREIDERICA PHARMACY AND COMPOUNDING
Street 400 W CAPITOL, SUITE 101A
City LITTLE ROCK
State AR
ZIP 72201
Phone 501 374-2207
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/5/2024
Certificate Expiration Date 8/4/2026
Facility Type Pharmacy
Lab Director MR. WALTER L. FRUCHEY

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