04D2022699 CLIA NUMBER - WALGREENS #12418

Laboratory Demographics

  • CLIA Code: 04D2022699
  • Facility Name: WALGREENS #12418
  • Facility Address: 115 COMMONS DR
    MAUMELLE, AR
    ZIP 72113
  • Facility Phone: 501 803-3274
  • Facility Type: Other - COVID 19 TEST SITE
  • Facility Type: Waiver
  • Lab Director: SHANE R B FARMER
  • NPI Number: 1932338779
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2022699
LAB Type Other - COVID 19 TEST SITE
Facility Name WALGREENS #12418
Street 115 COMMONS DR
City MAUMELLE
State AR
ZIP 72113
Phone 501 803-3274
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/26/2025
Certificate Expiration Date 1/25/2027
Facility Type Other - COVID 19 TEST SITE
Lab Director SHANE R B FARMER

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