04D2063040 CLIA NUMBER - WALGREENS #11161

Laboratory Demographics

  • CLIA Code: 04D2063040
  • Facility Name: WALGREENS #11161
  • Facility Address: 2401 MALCOLM AVE
    NEWPORT, AR
    ZIP 72112
  • Facility Phone: 870 217-0170
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: FRANCISCO M. MADRID
  • NPI Number: 1609044528
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2063040
LAB Type Pharmacy
Facility Name WALGREENS #11161
Street 2401 MALCOLM AVE
City NEWPORT
State AR
ZIP 72112
Phone 870 217-0170
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/31/2025
Certificate Expiration Date 3/30/2027
Facility Type Pharmacy
Lab Director FRANCISCO M. MADRID

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