04D2139507 CLIA NUMBER - WALMART PHARMACY 10-0004

Laboratory Demographics

  • CLIA Code: 04D2139507
  • Facility Name: WALMART PHARMACY 10-0004
  • Facility Address: 2901 HWY 412 E
    SILOAM SPRINGS, AR
    ZIP 72761
  • Facility Phone: 479 524-3156
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. BRADLEY H. PAULK
  • NPI Number: 1821404468
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139507
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0004
Street 2901 HWY 412 E
City SILOAM SPRINGS
State AR
ZIP 72761
Phone 479 524-3156
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Pharmacy
Lab Director MR. BRADLEY H. PAULK

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