04D2129829 CLIA NUMBER - WALMART PHARMACY 10-3331

Laboratory Demographics

  • CLIA Code: 04D2129829
  • Facility Name: WALMART PHARMACY 10-3331
  • Facility Address: 5501 S OLIVE ST
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 879-1420
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SHANNON RANEY
  • NPI Number: 1790702108
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2129829
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3331
Street 5501 S OLIVE ST
City PINE BLUFF
State AR
ZIP 71603
Phone 870 879-1420
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 SHANNON RANEY

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