04D2219580 CLIA NUMBER - WALGREENS #15788

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Laboratory Demographics

CLIA Number: 04D2219580

Facility Name: WALGREENS #15788

Facility Address:
900 N 6TH ST
BLYTHEVILLE, AR
ZIP 72315
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Facility Phone Number: 870 763-4507

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1346323755

Taxonomy: 333600000X - Pharmacy
A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

CLIA Record

Field Name	Field Value
CLIA Number	04D2219580
LAB Type	Pharmacy
Facility Name	WALGREENS #15788
Street	900 N 6TH ST
City	BLYTHEVILLE
State	AR
ZIP	72315
Phone	870 763-4507
CertificateType	4
CertificateEffectiveDate	4/6/2023
CertificateExpirationDate	4/5/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024