04D2234351 CLIA NUMBER - MCCOY TYGART DRUG

Laboratory Demographics

CLIA Number: 04D2234351

Facility Name: MCCOY TYGART DRUG

Facility Address:
821 N ROCK ST
SHERIDAN, AR
ZIP 72150
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Facility Phone Number: 870 942-5121

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1346876018

Taxonomy: 3336L0003X - Pharmacy
A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements.

CLIA Record

Field Name	Field Value
CLIA Number	04D2234351
LAB Type	Pharmacy
Facility Name	MCCOY TYGART DRUG
Street	821 N ROCK ST
City	SHERIDAN
State	AR
ZIP	72150
Phone	870 942-5121
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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