04D2013622 CLIA NUMBER - WALGREENS #05475

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Laboratory Demographics

CLIA Number: 04D2013622

Facility Name: WALGREENS #05475

Facility Address:
300 E TOWNSHIP ST
FAYETTEVILLE, AR
ZIP 72703
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Facility Phone Number: 479 582-0098

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1376558635

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	04D2013622
LAB Type	Pharmacy
Facility Name	WALGREENS #05475
Street	300 E TOWNSHIP ST
City	FAYETTEVILLE
State	AR
ZIP	72703
Phone	479 582-0098
CertificateType	4
CertificateEffectiveDate	5/25/2023
CertificateExpirationDate	5/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024