04D2127864 CLIA NUMBER - WALMART PHARMACY 10-0160

Laboratory Demographics

  • CLIA Code: 04D2127864
  • Facility Name: WALMART PHARMACY 10-0160
  • Facility Address: 219 HIGHWAY 412
    ASH FLAT, AR
    ZIP 72513
  • Facility Phone: 870 994-2152
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DELANA MONTGOMERY
  • NPI Number: 1922025428
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2127864
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0160
Street 219 HIGHWAY 412
City ASH FLAT
State AR
ZIP 72513
Phone 870 994-2152
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/21/2025
Certificate Expiration Date 3/20/2027
Facility Type Pharmacy
Lab Director DELANA MONTGOMERY

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