04D2139514 CLIA NUMBER - WALMART PHARMACY 10-4460

Laboratory Demographics

  • CLIA Code: 04D2139514
  • Facility Name: WALMART PHARMACY 10-4460
  • Facility Address: 12001 MAUMELLE BLVD
    N LITTLE ROCK, AR
    ZIP 72113
  • Facility Phone: 501 851-6459
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BONNIE CHANDLER
  • NPI Number: 1992981336
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139514
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4460
Street 12001 MAUMELLE BLVD
City N LITTLE ROCK
State AR
ZIP 72113
Phone 501 851-6459
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 BONNIE CHANDLER

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