04D2219242 CLIA NUMBER - WALGREENS #10586

Laboratory Demographics

  • CLIA Code: 04D2219242
  • Facility Name: WALGREENS #10586
  • Facility Address: 440 HIGHWAY 412 W
    SILOAM SPRINGS, AR
    ZIP 72761
  • Facility Phone: 479 524-3671
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BLIA T. VANG
  • NPI Number: 1588701692
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2219242
LAB Type Pharmacy
Facility Name WALGREENS #10586
Street 440 HIGHWAY 412 W
City SILOAM SPRINGS
State AR
ZIP 72761
Phone 479 524-3671
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/2/2025
Certificate Expiration Date 4/1/2027
Facility Type Pharmacy
Lab Director BLIA T. VANG

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