04D2058917 CLIA NUMBER - WALGREENS #05730

Laboratory Demographics

  • CLIA Code: 04D2058917
  • Facility Name: WALGREENS #05730
  • Facility Address: 3710 S UNIVERSITY AVE
    LITTLE ROCK, AR
    ZIP 72204
  • Facility Phone: 501 568-1486
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES JOHNSON
  • NPI Number: 1861408247
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2058917
LAB Type Pharmacy
Facility Name WALGREENS #05730
Street 3710 S UNIVERSITY AVE
City LITTLE ROCK
State AR
ZIP 72204
Phone 501 568-1486
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director CHARLES JOHNSON

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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