04D2070952 CLIA NUMBER - WALGREENS #09813

Laboratory Demographics

  • CLIA Code: 04D2070952
  • Facility Name: WALGREENS #09813
  • Facility Address: 2503 W PLEASANT GROVE ROAD
    ROGERS, AR
    ZIP 72758
  • Facility Phone: 479 936-8079
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. MICHAEL J. KOENIGS
  • NPI Number: 1639302730
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2070952
LAB Type Pharmacy
Facility Name WALGREENS #09813
Street 2503 W PLEASANT GROVE ROAD
City ROGERS
State AR
ZIP 72758
Phone 479 936-8079
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/10/2025
Certificate Expiration Date 2/9/2027
Facility Type Pharmacy
Lab Director DR. MICHAEL J. KOENIGS

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