04D2067509 CLIA NUMBER - WALGREENS #15792

Laboratory Demographics

  • CLIA Code: 04D2067509
  • Facility Name: WALGREENS #15792
  • Facility Address: 8815 STAGECOACH RD
    LITTLE ROCK, AR
    ZIP 72210
  • Facility Phone: 501 455-8080
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANITA L. AIMOE
  • NPI Number: 1265661987
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2067509
LAB Type Pharmacy
Facility Name WALGREENS #15792
Street 8815 STAGECOACH RD
City LITTLE ROCK
State AR
ZIP 72210
Phone 501 455-8080
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/28/2025
Certificate Expiration Date 5/27/2027
Facility Type Pharmacy
Lab Director ANITA L. AIMOE

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