04D2065902 CLIA NUMBER - WALGREENS #10365

Laboratory Demographics

  • CLIA Code: 04D2065902
  • Facility Name: WALGREENS #10365
  • Facility Address: 308 S MAIN ST
    MALVERN, AR
    ZIP 72104
  • Facility Phone: 501 467-8197
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LACY MINGE
  • NPI Number: 1154607224
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2065902
LAB Type Pharmacy
Facility Name WALGREENS #10365
Street 308 S MAIN ST
City MALVERN
State AR
ZIP 72104
Phone 501 467-8197
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/27/2025
Certificate Expiration Date 4/26/2027
Facility Type Pharmacy
Lab Director LACY MINGE

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