04D2059424 CLIA NUMBER - WALGREENS #15243

Laboratory Demographics

  • CLIA Code: 04D2059424
  • Facility Name: WALGREENS #15243
  • Facility Address: 3202 WEST MAIN
    RUSSELLVILLE, AR
    ZIP 72801
  • Facility Phone: 479 880-0181
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IVELISSE LOVETT
  • NPI Number: 1770838518
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2059424
LAB Type Pharmacy
Facility Name WALGREENS #15243
Street 3202 WEST MAIN
City RUSSELLVILLE
State AR
ZIP 72801
Phone 479 880-0181
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/22/2025
Certificate Expiration Date 4/21/2027
Facility Type Pharmacy
Lab Director IVELISSE LOVETT

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