04D2219246 CLIA NUMBER - WALGREENS #07235

Laboratory Demographics

  • CLIA Code: 04D2219246
  • Facility Name: WALGREENS #07235
  • Facility Address: 1601 FAYETTEVILLE RD
    VAN BUREN, AR
    ZIP 72956
  • Facility Phone: 479 474-8859
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: STELLA Y. KOUEMO
  • NPI Number: 1063427326
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2219246
LAB Type Pharmacy
Facility Name WALGREENS #07235
Street 1601 FAYETTEVILLE RD
City VAN BUREN
State AR
ZIP 72956
Phone 479 474-8859
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 STELLA Y. KOUEMO

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