04D2139428 CLIA NUMBER - WALMART PHARMACY 10-0091

Laboratory Demographics

  • CLIA Code: 04D2139428
  • Facility Name: WALMART PHARMACY 10-0091
  • Facility Address: 205 DEADRICK RD
    FORREST CITY, AR
    ZIP 72335
  • Facility Phone: 870 633-0465
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. JAMES D. SCOGGIN
  • NPI Number: 1265517874
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 04D2139428
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0091
Street 205 DEADRICK RD
City FORREST CITY
State AR
ZIP 72335
Phone 870 633-0465
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. JAMES D. SCOGGIN

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