04D2134421 CLIA NUMBER - WALMART PHARMACY 10-0279

Laboratory Demographics

  • CLIA Code: 04D2134421
  • Facility Name: WALMART PHARMACY 10-0279
  • Facility Address: 926 E COLLIN RAYE DR
    DE QUEEN, AR
    ZIP 71832
  • Facility Phone: 870 642-6921
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBIUL MOSTAFA
  • NPI Number: 1063439453
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2134421
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0279
Street 926 E COLLIN RAYE DR
City DE QUEEN
State AR
ZIP 71832
Phone 870 642-6921
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/2/2025
Certificate Expiration Date 8/1/2027
Facility Type Pharmacy
Lab Director ROBIUL MOSTAFA

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