04D2039713 CLIA NUMBER - WALGREENS #02774

Laboratory Demographics

  • CLIA Code: 04D2039713
  • Facility Name: WALGREENS #02774
  • Facility Address: 346 W BROADWAY ST
    WEST MEMPHIS, AR
    ZIP 72301
  • Facility Phone: 870 733-0138
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHANCE CASH
  • NPI Number: 1942817101
  • Taxonomy: 183500000X - Pharmacist

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CLIA Record

Field Name Field Value
CLIA Number 04D2039713
LAB Type Pharmacy
Facility Name WALGREENS #02774
Street 346 W BROADWAY ST
City WEST MEMPHIS
State AR
ZIP 72301
Phone 870 733-0138
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 CHANCE CASH

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