04D2285951 CLIA NUMBER - ELLISON FAMILY PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2285951
  • Facility Name: ELLISON FAMILY PHARMACY
  • Facility Address: 601 HWY 71 N
    MENA, AR
    ZIP 71953
  • Facility Phone: 479 385-9400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEVI M. ELLISON
  • NPI Number: 1407556608
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2285951
LAB Type Pharmacy
Facility Name ELLISON FAMILY PHARMACY
Street 601 HWY 71 N
City MENA
State AR
ZIP 71953
Phone 479 385-9400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/20/2025
Certificate Expiration Date 7/19/2027
Facility Type Pharmacy
Lab Director LEVI M. ELLISON

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