04D2204918 CLIA NUMBER - PROFESSIONAL PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2204918
  • Facility Name: PROFESSIONAL PHARMACY
  • Facility Address: 1515 N MEDICAL DRIVE
    STUTTGART, AR
    ZIP 72160
  • Facility Phone: 870 673-1741
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ZACHARY J. SMITH
  • NPI Number: 1457565400
  • Taxonomy: 3336L0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2204918
LAB Type Pharmacy
Facility Name PROFESSIONAL PHARMACY
Street 1515 N MEDICAL DRIVE
City STUTTGART
State AR
ZIP 72160
Phone 870 673-1741
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Pharmacy
Lab Director ZACHARY J. SMITH

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