04D2069784 CLIA NUMBER - WALGREENS #15793

Laboratory Demographics

  • CLIA Code: 04D2069784
  • Facility Name: WALGREENS #15793
  • Facility Address: 803 HIGHWAY 71 N
    MENA, AR
    ZIP 71953
  • Facility Phone: 479 394-5144
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: HAROLD SMITH
  • NPI Number: 1639157092
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2069784
LAB Type Pharmacy
Facility Name WALGREENS #15793
Street 803 HIGHWAY 71 N
City MENA
State AR
ZIP 71953
Phone 479 394-5144
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/19/2025
Certificate Expiration Date 5/18/2027
Facility Type Pharmacy
Lab Director HAROLD SMITH

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