04D2013286 CLIA NUMBER - WALGREENS #06959

Laboratory Demographics

  • CLIA Code: 04D2013286
  • Facility Name: WALGREENS #06959
  • Facility Address: 702 MILITARY RD
    BENTON, AR
    ZIP 72015
  • Facility Phone: 847 527-4274
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRISTINA KELLEY
  • NPI Number: 1902811268
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2013286
LAB Type Pharmacy
Facility Name WALGREENS #06959
Street 702 MILITARY RD
City BENTON
State AR
ZIP 72015
Phone 847 527-4274
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director CHRISTINA KELLEY

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