04D2275312 CLIA NUMBER - COLLIER DRUG - PRAIRIE GROVE

Laboratory Demographics

  • CLIA Code: 04D2275312
  • Facility Name: COLLIER DRUG - PRAIRIE GROVE
  • Facility Address: 801 E DOUGLAS
    PRAIRIE GROVE, AR
    ZIP 72753
  • Facility Phone: 479 846-2195
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRENTON DUNN
  • NPI Number: 1003816174
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2275312
LAB Type Pharmacy
Facility Name COLLIER DRUG - PRAIRIE GROVE
Street 801 E DOUGLAS
City PRAIRIE GROVE
State AR
ZIP 72753
Phone 479 846-2195
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/19/2025
Certificate Expiration Date 1/18/2027
Facility Type Pharmacy
Lab Director TRENTON DUNN

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