04D2230007 CLIA NUMBER - ECONO-MED OF WALNUT RIDGE

Laboratory Demographics

CLIA Number: 04D2230007

Facility Name: ECONO-MED OF WALNUT RIDGE

Facility Address:
1045 W MAIN ST SUITE B
WALNUT RIDGE, AR
ZIP 72476
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Facility Phone Number: 870 886-5200

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1063948289

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	04D2230007
LAB Type	Pharmacy
Facility Name	ECONO-MED OF WALNUT RIDGE
Street	1045 W MAIN ST SUITE B
City	WALNUT RIDGE
State	AR
ZIP	72476
Phone	870 886-5200
CertificateType	4
CertificateEffectiveDate	7/19/2023
CertificateExpirationDate	7/18/2025
FacilityType	Waiver

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