04D2063021 CLIA NUMBER - WALGREENS #21379

Laboratory Demographics

  • CLIA Code: 04D2063021
  • Facility Name: WALGREENS #21379
  • Facility Address: 5905 DOLLARWAY RD
    PINE BLUFF, AR
    ZIP 71602
  • Facility Phone: 873 534-7868
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRANDON VAN
  • NPI Number: 1851475990
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2063021
LAB Type Pharmacy
Facility Name WALGREENS #21379
Street 5905 DOLLARWAY RD
City PINE BLUFF
State AR
ZIP 71602
Phone 873 534-7868
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 BRANDON VAN

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