04D2139395 CLIA NUMBER - WALMART PHARMACY 10-0016

Laboratory Demographics

  • CLIA Code: 04D2139395
  • Facility Name: WALMART PHARMACY 10-0016
  • Facility Address: 2214 FAYETTEVILLE RD
    VAN BUREN, AR
    ZIP 72956
  • Facility Phone: 479 474-5051
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DENNY DOSS
  • NPI Number: 1104228386
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139395
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0016
Street 2214 FAYETTEVILLE RD
City VAN BUREN
State AR
ZIP 72956
Phone 479 474-5051
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 DENNY DOSS

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