04D2257492 CLIA NUMBER - COMMUNITY CARE RX

Laboratory Demographics

  • CLIA Code: 04D2257492
  • Facility Name: COMMUNITY CARE RX
  • Facility Address: 1606 MARTIN LUTHER KING BLVD
    MALVERN, AR
    ZIP 72104
  • Facility Phone: 501 229-1446
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHELYN YVONNE DAVIS
  • NPI Number: 1750859195
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2257492
LAB Type Pharmacy
Facility Name COMMUNITY CARE RX
Street 1606 MARTIN LUTHER KING BLVD
City MALVERN
State AR
ZIP 72104
Phone 501 229-1446
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2024
Certificate Expiration Date 4/5/2026
Facility Type Pharmacy
Lab Director SHELYN YVONNE DAVIS

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