04D2013521 CLIA NUMBER - WALGREENS #05789

Laboratory Demographics

  • CLIA Code: 04D2013521
  • Facility Name: WALGREENS #05789
  • Facility Address: 1800 N MISSOURI ST
    WEST MEMPHIS, AR
    ZIP 72301
  • Facility Phone: 870 735-8987
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VINCE S. LOVELY
  • NPI Number: 1659386910
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2013521
LAB Type Pharmacy
Facility Name WALGREENS #05789
Street 1800 N MISSOURI ST
City WEST MEMPHIS
State AR
ZIP 72301
Phone 870 735-8987
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Pharmacy
Lab Director VINCE S. LOVELY

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