04D2127850 CLIA NUMBER - WALMART PHARMACY 10-0169

Laboratory Demographics

  • CLIA Code: 04D2127850
  • Facility Name: WALMART PHARMACY 10-0169
  • Facility Address: 322 BROWNSVILLE LOOP
    LONOKE, AR
    ZIP 72086
  • Facility Phone: 501 676-3191
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LESLIE GREEN
  • NPI Number: 1962429357
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2127850
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0169
Street 322 BROWNSVILLE LOOP
City LONOKE
State AR
ZIP 72086
Phone 501 676-3191
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/20/2025
Certificate Expiration Date 3/19/2027
Facility Type Pharmacy
Lab Director LESLIE GREEN

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