04D2238294 CLIA NUMBER - GOSNELL DRUGS

Laboratory Demographics

  • CLIA Code: 04D2238294
  • Facility Name: GOSNELL DRUGS
  • Facility Address: 134BEVILL AVE
    GOSNELL, AR
    ZIP 72315
  • Facility Phone: 870 751-9242
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WALLACE TYSON
  • NPI Number: 1770055923
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2238294
LAB Type Pharmacy
Facility Name GOSNELL DRUGS
Street 134BEVILL AVE
City GOSNELL
State AR
ZIP 72315
Phone 870 751-9242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/1/2025
Certificate Expiration Date 9/30/2027
Facility Type Pharmacy
Lab Director WALLACE TYSON

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