04D2117326 CLIA NUMBER - WALMART PHARMACY 10-0128

Laboratory Demographics

  • CLIA Code: 04D2117326
  • Facility Name: WALMART PHARMACY 10-0128
  • Facility Address: 1911 W PARKER ROAD
    JONESBORO, AR
    ZIP 72404
  • Facility Phone: 479 258-2243
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. JESSY HARRELL
  • NPI Number: 1326065723
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2117326
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0128
Street 1911 W PARKER ROAD
City JONESBORO
State AR
ZIP 72404
Phone 479 258-2243
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Pharmacy
Lab Director MS. JESSY HARRELL

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