04D2139449 CLIA NUMBER - WALMART PHARMACY 10-0144

Laboratory Demographics

  • CLIA Code: 04D2139449
  • Facility Name: WALMART PHARMACY 10-0144
  • Facility Address: 2875 W MARTIN LUTHER KING JR BLVD
    FAYETTEVILLE, AR
    ZIP 72704
  • Facility Phone: 479 521-4350
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRISTAN MYERS
  • NPI Number: 1255358636
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139449
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0144
Street 2875 W MARTIN LUTHER KING JR BLVD
City FAYETTEVILLE
State AR
ZIP 72704
Phone 479 521-4350
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 TRISTAN MYERS

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