04D2139438 CLIA NUMBER - WALMART PHARMACY 10-1105

Laboratory Demographics

  • CLIA Code: 04D2139438
  • Facility Name: WALMART PHARMACY 10-1105
  • Facility Address: 4450 E MCCAIN BLVD
    NORTH LITTLE ROCK, AR
    ZIP 72117
  • Facility Phone: 501 945-9400
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. MORADEKE BLACK
  • NPI Number: 1053338442
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139438
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1105
Street 4450 E MCCAIN BLVD
City NORTH LITTLE ROCK
State AR
ZIP 72117
Phone 501 945-9400
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 MS. MORADEKE BLACK

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