04D2139457 CLIA NUMBER - WALMART PHARMACY 10-0339

Laboratory Demographics

  • CLIA Code: 04D2139457
  • Facility Name: WALMART PHARMACY 10-0339
  • Facility Address: 1123 HWY 79 167 BYPASS
    FORDYCE, AR
    ZIP 71742
  • Facility Phone: 870 352-8034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. DEREK T. WHITE
  • NPI Number: 1235156639
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139457
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0339
Street 1123 HWY 79 167 BYPASS
City FORDYCE
State AR
ZIP 71742
Phone 870 352-8034
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. DEREK T. WHITE

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