04D2058918 CLIA NUMBER - WALGREENS #15361

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Laboratory Demographics

CLIA Number: 04D2058918

Facility Name: WALGREENS #15361

Facility Address:
2503 W 28 AVE
PINE BLUFF, AR
ZIP 71603
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Facility Phone Number: 870 850-6084

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1265515670

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

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
CertificateType	4
CertificateEffectiveDate	4/27/2023
CertificateExpirationDate	4/26/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024