04D2139392 CLIA NUMBER - WALMART PHARMACY 10-0002

Laboratory Demographics

  • CLIA Code: 04D2139392
  • Facility Name: WALMART PHARMACY 10-0002
  • Facility Address: 161 N WALMART DRIVE
    HARRISON, AR
    ZIP 72601
  • Facility Phone: 870 741-2327
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KYLE B. JOHNSON
  • NPI Number: 1538247945
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 04D2139392
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0002
Street 161 N WALMART DRIVE
City HARRISON
State AR
ZIP 72601
Phone 870 741-2327
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Pharmacy
Lab Director KYLE B. JOHNSON

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