04D2216511 CLIA NUMBER - CVS/PHARMACY #10409 ARKANSAS CVS PHARMACY, LLC

Laboratory Demographics

  • CLIA Code: 04D2216511
  • Facility Name: CVS/PHARMACY #10409 ARKANSAS CVS PHARMACY, LLC
  • Facility Address: 2402 N COLLEGE AVENUE
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 401 770-6431
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELLEN BOWNE
  • NPI Number: 1912306036
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2216511
LAB Type Pharmacy
Facility Name CVS/PHARMACY #10409 ARKANSAS CVS PHARMACY, LLC
Street 2402 N COLLEGE AVENUE
City FAYETTEVILLE
State AR
ZIP 72703
Phone 401 770-6431
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/12/2025
Certificate Expiration Date 3/11/2027
Facility Type Pharmacy
Lab Director KELLEN BOWNE

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