04D2063029 CLIA NUMBER - WALGREENS #10897

Laboratory Demographics

  • CLIA Code: 04D2063029
  • Facility Name: WALGREENS #10897
  • Facility Address: 1644 E MAIN ST
    MAGNOLIA, AR
    ZIP 71753
  • Facility Phone: 870 234-3493
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MONICA L. MACK
  • NPI Number: 1235321332
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2063029
LAB Type Pharmacy
Facility Name WALGREENS #10897
Street 1644 E MAIN ST
City MAGNOLIA
State AR
ZIP 71753
Phone 870 234-3493
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2023
Certificate Expiration Date 4/26/2025
Facility Type Pharmacy
Lab Director MONICA L. MACK

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This page was last updated on: 3/20/2025