04D2128192 CLIA NUMBER - WALMART PHARMACY 10-0068

Laboratory Demographics

  • CLIA Code: 04D2128192
  • Facility Name: WALMART PHARMACY 10-0068
  • Facility Address: 800 HIGHWAY 64 E
    WYNNE, AR
    ZIP 72396
  • Facility Phone: 870 238-7146
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: COURTNEY BETHELL
  • NPI Number: 1336166727
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2128192
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0068
Street 800 HIGHWAY 64 E
City WYNNE
State AR
ZIP 72396
Phone 870 238-7146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/27/2025
Certificate Expiration Date 3/26/2027
Facility Type Pharmacy
Lab Director COURTNEY BETHELL

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