04D2247630 CLIA NUMBER - PARK WEST PHARMACY DALTON HERZIG INC

Laboratory Demographics

  • CLIA Code: 04D2247630
  • Facility Name: PARK WEST PHARMACY DALTON HERZIG INC
  • Facility Address: 904 AUTUMN ROAD STE 275
    LITTLE ROCK, AR
    ZIP 72211
  • Facility Phone: 501 224-3499
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSE N. PRUITT
  • NPI Number: 1053308940
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2247630
LAB Type Pharmacy
Facility Name PARK WEST PHARMACY DALTON HERZIG INC
Street 904 AUTUMN ROAD STE 275
City LITTLE ROCK
State AR
ZIP 72211
Phone 501 224-3499
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2024
Certificate Expiration Date 1/6/2026
Facility Type Pharmacy
Lab Director JESSE N. PRUITT

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