04D2255929 CLIA NUMBER - CVS PHARMACY 11093 ARKANSAS CVS PHARMACY LLC

Laboratory Demographics

  • CLIA Code: 04D2255929
  • Facility Name: CVS PHARMACY 11093 ARKANSAS CVS PHARMACY LLC
  • Facility Address: 101 EAST MAIN STREET
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 866 389-2727
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIFER HARRELL
  • NPI Number: 1134617301
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2255929
LAB Type Pharmacy
Facility Name CVS PHARMACY 11093 ARKANSAS CVS PHARMACY LLC
Street 101 EAST MAIN STREET
City RUSSELLVILLE
State AR
ZIP 72801
Phone 866 389-2727
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/18/2024
Certificate Expiration Date 3/17/2026
Facility Type Pharmacy
Lab Director JENNIFER HARRELL

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