04D2219580 CLIA NUMBER - WALGREENS #15788

Laboratory Demographics

  • CLIA Code: 04D2219580
  • Facility Name: WALGREENS #15788
  • Facility Address: 900 N 6TH ST
    BLYTHEVILLE, AR
    ZIP 72315
  • Facility Phone: 870 763-4507
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIKA WANNER
  • NPI Number: 1346323755
  • Taxonomy: 333600000X - Pharmacy

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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
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/6/2025
Certificate Expiration Date 4/5/2027
Facility Type Pharmacy
Lab Director ERIKA WANNER

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