04D2129828 CLIA NUMBER - WALMART PHARMACY 10-0289

Laboratory Demographics

  • CLIA Code: 04D2129828
  • Facility Name: WALMART PHARMACY 10-0289
  • Facility Address: US 65 SOUTH
    MCGEHEE, AR
    ZIP 71654
  • Facility Phone: 870 222-6233
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MENOTTI G. TOMA
  • NPI Number: 1356364418
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2129828
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0289
Street US 65 SOUTH
City MCGEHEE
State AR
ZIP 71654
Phone 870 222-6233
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2025
Certificate Expiration Date 4/25/2027
Facility Type Pharmacy
Lab Director MENOTTI G. TOMA

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