04D2243538 CLIA NUMBER - EXPRESS RX OF PRESCOTT

Laboratory Demographics

  • CLIA Code: 04D2243538
  • Facility Name: EXPRESS RX OF PRESCOTT
  • Facility Address: 1430 WEST 1ST STREET N
    PRESCOTT, AR
    ZIP 71857
  • Facility Phone: 870 850-0158
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC CRUMBAUGH
  • NPI Number: 1992875074
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2243538
LAB Type Pharmacy
Facility Name EXPRESS RX OF PRESCOTT
Street 1430 WEST 1ST STREET N
City PRESCOTT
State AR
ZIP 71857
Phone 870 850-0158
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2023
Certificate Expiration Date 11/18/2025
Facility Type Pharmacy
Lab Director ERIC CRUMBAUGH

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