04D2132904 CLIA NUMBER - WALMART PHARMACY 10-0054

Laboratory Demographics

  • CLIA Code: 04D2132904
  • Facility Name: WALMART PHARMACY 10-0054
  • Facility Address: 2004 S PLEASANT STREET
    SPRINGDALE, AR
    ZIP 72764
  • Facility Phone: 479 756-0860
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARTHA L. GANN
  • NPI Number: 1457596587
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2132904
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0054
Street 2004 S PLEASANT STREET
City SPRINGDALE
State AR
ZIP 72764
Phone 479 756-0860
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/29/2025
Certificate Expiration Date 6/28/2027
Facility Type Pharmacy
Lab Director MARTHA L. GANN

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