04D2102259 CLIA NUMBER - WALMART PHARMACY 10-4516

Laboratory Demographics

  • CLIA Code: 04D2102259
  • Facility Name: WALMART PHARMACY 10-4516
  • Facility Address: 660 W MARTIN LUTHER KING BLVD
    FAYETTEVILLE, AR
    ZIP 72701
  • Facility Phone: 479 273-6418
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TYLER SWEAT
  • NPI Number: 1295190510
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2102259
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4516
Street 660 W MARTIN LUTHER KING BLVD
City FAYETTEVILLE
State AR
ZIP 72701
Phone 479 273-6418
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/18/2025
Certificate Expiration Date 9/17/2027
Facility Type Pharmacy
Lab Director TYLER SWEAT

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