04D2128130 CLIA NUMBER - WALMART PHARMACY 10-0011

Laboratory Demographics

  • CLIA Code: 04D2128130
  • Facility Name: WALMART PHARMACY 10-0011
  • Facility Address: 65 WAL MART DR
    MOUNTAIN HOME, AR
    ZIP 72653
  • Facility Phone: 870 492-7733
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANTHONY STEPHENS
  • NPI Number: 1912080466
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 04D2128130
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0011
Street 65 WAL MART DR
City MOUNTAIN HOME
State AR
ZIP 72653
Phone 870 492-7733
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/24/2025
Certificate Expiration Date 3/23/2027
Facility Type Pharmacy
Lab Director ANTHONY STEPHENS

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