04D2313009 CLIA NUMBER - CLINIC PHARMACY OF MONTICELLO

Laboratory Demographics

  • CLIA Code: 04D2313009
  • Facility Name: CLINIC PHARMACY OF MONTICELLO
  • Facility Address: 535 JORDAN DR, SUITE B
    MONTICELLO, AR
    ZIP 71655
  • Facility Phone: 870 224-0650
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JENNIE STATEN
  • NPI Number: 1013589514
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2313009
LAB Type Pharmacy
Facility Name CLINIC PHARMACY OF MONTICELLO
Street 535 JORDAN DR, SUITE B
City MONTICELLO
State AR
ZIP 71655
Phone 870 224-0650
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/23/2024
Certificate Expiration Date 10/22/2026
Facility Type Pharmacy
Lab Director JENNIE STATEN

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