04D2209681 CLIA NUMBER - PALACE DRUG BURNS RX LLC

Laboratory Demographics

  • CLIA Code: 04D2209681
  • Facility Name: PALACE DRUG BURNS RX LLC
  • Facility Address: 270 MAIN ST
    MAMMOTH SPRING, AR
    ZIP 72554
  • Facility Phone: 870 625-3222
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHAEL J. CLARK
  • NPI Number: 1558390633
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2209681
LAB Type Pharmacy
Facility Name PALACE DRUG BURNS RX LLC
Street 270 MAIN ST
City MAMMOTH SPRING
State AR
ZIP 72554
Phone 870 625-3222
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/15/2025
Certificate Expiration Date 1/14/2027
Facility Type Pharmacy
Lab Director MICHAEL J. CLARK

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