04D2139511 CLIA NUMBER - WALMART PHARMACY 10-5837

Laboratory Demographics

  • CLIA Code: 04D2139511
  • Facility Name: WALMART PHARMACY 10-5837
  • Facility Address: 5000 PAULINE WHITAKER PRKWY
    ROGERS, AR
    ZIP 72758
  • Facility Phone: 479 254-6806
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MS. YUE PHANG VANG
  • NPI Number: 1750515631
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139511
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5837
Street 5000 PAULINE WHITAKER PRKWY
City ROGERS
State AR
ZIP 72758
Phone 479 254-6806
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 MS. YUE PHANG VANG

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