04D2139425 CLIA NUMBER - WALMART PHARMACY 10-0058

Laboratory Demographics

  • CLIA Code: 04D2139425
  • Facility Name: WALMART PHARMACY 10-0058
  • Facility Address: 2409 MAIN STREET
    RUSSELLVILLE, AR
    ZIP 72802
  • Facility Phone: 479 968-2970
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. RYAN HIGGS
  • NPI Number: 1326121245
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2139425
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0058
Street 2409 MAIN STREET
City RUSSELLVILLE
State AR
ZIP 72802
Phone 479 968-2970
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/3/2023
Certificate Expiration Date 11/2/2025
Facility Type Pharmacy
Lab Director MR. RYAN HIGGS

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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