04D2139442 CLIA NUMBER - WALMART PHARMACY 10-2575

Laboratory Demographics

  • CLIA Code: 04D2139442
  • Facility Name: WALMART PHARMACY 10-2575
  • Facility Address: 3900 DAVE WARD DR
    CONWAY, AR
    ZIP 72034
  • Facility Phone: 501 328-5000
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. STACIE RUFF
  • NPI Number: 1134146533
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139442
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2575
Street 3900 DAVE WARD DR
City CONWAY
State AR
ZIP 72034
Phone 501 328-5000
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. STACIE RUFF

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