04D2314146 CLIA NUMBER - STATE LINE PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2314146
  • Facility Name: STATE LINE PHARMACY
  • Facility Address: 501 N MAIN ST
    JUNCTION CITY, AR
    ZIP 71749
  • Facility Phone: 870 843-6028
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAMI L. LUCAS
  • NPI Number: 1790479087
  • Taxonomy: 3336C0003X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2314146
LAB Type Pharmacy
Facility Name STATE LINE PHARMACY
Street 501 N MAIN ST
City JUNCTION CITY
State AR
ZIP 71749
Phone 870 843-6028
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/14/2024
Certificate Expiration Date 11/13/2026
Facility Type Pharmacy
Lab Director JAMI L. LUCAS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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