04D2013622 CLIA NUMBER - WALGREENS #05475

Laboratory Demographics

  • CLIA Code: 04D2013622
  • Facility Name: WALGREENS #05475
  • Facility Address: 300 E TOWNSHIP ST
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 582-0098
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIN E. DERKS
  • NPI Number: 1376558635
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/25/2025
Certificate Expiration Date 5/24/2027
Facility Type Pharmacy
Lab Director ERIN E. DERKS

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