04D2062967 CLIA NUMBER - WALGREENS #10240

Laboratory Demographics

  • CLIA Code: 04D2062967
  • Facility Name: WALGREENS #10240
  • Facility Address: 5500 HIGHWAY 5 N
    BRYANT, AR
    ZIP 72022
  • Facility Phone: 501 847-7420
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MATTHEW A. DEVERS
  • NPI Number: 1972544393
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2062967
LAB Type Pharmacy
Facility Name WALGREENS #10240
Street 5500 HIGHWAY 5 N
City BRYANT
State AR
ZIP 72022
Phone 501 847-7420
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 MATTHEW A. DEVERS

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