04D2194404 CLIA NUMBER - MITCHELL'S MAIN STREET PHARMACY

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Laboratory Demographics

CLIA Number: 04D2194404

Facility Name: MITCHELL'S MAIN STREET PHARMACY

Facility Address:
214 EAST MAIN
MOUNTAIN VIEW, AR
ZIP 72560
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Facility Phone Number: 870 269-3253

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1447503941

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	04D2194404
LAB Type	Pharmacy
Facility Name	MITCHELL'S MAIN STREET PHARMACY
Street	214 EAST MAIN
City	MOUNTAIN VIEW
State	AR
ZIP	72560
Phone	870 269-3253
CertificateType	4
CertificateEffectiveDate	9/30/2022
CertificateExpirationDate	9/29/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024