04D2139509 CLIA NUMBER - WALMART PHARMACY 10-0127

Laboratory Demographics

CLIA Number: 04D2139509

Facility Name: WALMART PHARMACY 10-0127

Facility Address:
1910 MLK BLVD
MALVERN, AR
ZIP 72104
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Facility Phone Number: 501 337-1170

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1336166719

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	04D2139509
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0127
Street	1910 MLK BLVD
City	MALVERN
State	AR
ZIP	72104
Phone	501 337-1170
CertificateType	4
CertificateEffectiveDate	11/6/2023
CertificateExpirationDate	11/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024