04D2139524 CLIA NUMBER - WALMART PHARMACY 10-7317

Laboratory Demographics

  • CLIA Code: 04D2139524
  • Facility Name: WALMART PHARMACY 10-7317
  • Facility Address: 75 SOUTH BROADVIEW STREET
    GREENBRIER, AR
    ZIP 72058
  • Facility Phone: 501 287-6003
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. DUSTIN BROWN
  • NPI Number: 1699176743
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139524
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-7317
Street 75 SOUTH BROADVIEW STREET
City GREENBRIER
State AR
ZIP 72058
Phone 501 287-6003
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. DUSTIN BROWN

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This page was last updated on: 3/20/2025