04D2058918 CLIA NUMBER - WALGREENS #15361

Laboratory Demographics

  • CLIA Code: 04D2058918
  • Facility Name: WALGREENS #15361
  • Facility Address: 2503 W 28 AVE
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 850-6084
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KENDRA Y. BEARDEN
  • NPI Number: 1265515670
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2058918
LAB Type Pharmacy
Facility Name WALGREENS #15361
Street 2503 W 28 AVE
City PINE BLUFF
State AR
ZIP 71603
Phone 870 850-6084
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Pharmacy
Lab Director KENDRA Y. BEARDEN

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