04D2063045 CLIA NUMBER - WALGREENS #15790

Laboratory Demographics

  • CLIA Code: 04D2063045
  • Facility Name: WALGREENS #15790
  • Facility Address: 191 W MAIN ST
    ASHDOWN, AR
    ZIP 71822
  • Facility Phone: 870 898-5151
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANGELA BERNARDE
  • NPI Number: 1821083619
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2063045
LAB Type Pharmacy
Facility Name WALGREENS #15790
Street 191 W MAIN ST
City ASHDOWN
State AR
ZIP 71822
Phone 870 898-5151
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/30/2025
Certificate Expiration Date 7/29/2027
Facility Type Pharmacy
Lab Director ANGELA BERNARDE

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