04D2139431 CLIA NUMBER - WALMART PHARMACY 10-0100

Laboratory Demographics

  • CLIA Code: 04D2139431
  • Facility Name: WALMART PHARMACY 10-0100
  • Facility Address: 406 S WALTON BLVD
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 479 273-5080
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MEGAN MANUEL
  • NPI Number: 1457378739
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139431
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0100
Street 406 S WALTON BLVD
City BENTONVILLE
State AR
ZIP 72712
Phone 479 273-5080
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 MEGAN MANUEL

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