04D2065901 CLIA NUMBER - WALGREENS #15817

Laboratory Demographics

  • CLIA Code: 04D2065901
  • Facility Name: WALGREENS #15817
  • Facility Address: 310 S MARTIN ST
    WARREN, AR
    ZIP 71671
  • Facility Phone: 870 226-3746
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TAYLOR N. ASHCRAFT
  • NPI Number: 1124102264
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2065901
LAB Type Pharmacy
Facility Name WALGREENS #15817
Street 310 S MARTIN ST
City WARREN
State AR
ZIP 71671
Phone 870 226-3746
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/19/2025
Certificate Expiration Date 10/18/2027
Facility Type Pharmacy
Lab Director TAYLOR N. ASHCRAFT

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