04D2063049 CLIA NUMBER - WALGREENS #15791

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Laboratory Demographics

CLIA Number: 04D2063049

Facility Name: WALGREENS #15791

Facility Address:
1601 MAIN ST
LITTLE ROCK, AR
ZIP 72206
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Facility Phone Number: 501 371-9229

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336375252

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	04D2063049
LAB Type	Pharmacy
Facility Name	WALGREENS #15791
Street	1601 MAIN ST
City	LITTLE ROCK
State	AR
ZIP	72206
Phone	501 371-9229
CertificateType	4
CertificateEffectiveDate	5/18/2023
CertificateExpirationDate	5/17/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024