04D2013533 CLIA NUMBER - WALGREENS #04794

Laboratory Demographics

  • CLIA Code: 04D2013533
  • Facility Name: WALGREENS #04794
  • Facility Address: 850 OAK ST
    CONWAY, AR
    ZIP 72032
  • Facility Phone: 501 327-5638
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ATHENA L. LEWALLEN
  • NPI Number: 1730194093
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2013533
LAB Type Pharmacy
Facility Name WALGREENS #04794
Street 850 OAK ST
City CONWAY
State AR
ZIP 72032
Phone 501 327-5638
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/8/2025
Certificate Expiration Date 6/7/2027
Facility Type Pharmacy
Lab Director ATHENA L. LEWALLEN

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