04D2139525 CLIA NUMBER - WALMART PHARMACY 10-5244

Laboratory Demographics

  • CLIA Code: 04D2139525
  • Facility Name: WALMART PHARMACY 10-5244
  • Facility Address: 19301 CANTRELL RD
    LITTLE ROCK, AR
    ZIP 72223
  • Facility Phone: 501 868-9654
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. DYLAN LADET
  • NPI Number: 1609893015
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2139525
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5244
Street 19301 CANTRELL RD
City LITTLE ROCK
State AR
ZIP 72223
Phone 501 868-9654
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. DYLAN LADET

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