04D2220175 CLIA NUMBER - WALGREENS #07847

Laboratory Demographics

  • CLIA Code: 04D2220175
  • Facility Name: WALGREENS #07847
  • Facility Address: 524 S SCHOOL AVE
    FAYETTEVILLE, AR
    ZIP 72701
  • Facility Phone: 479 251-1685
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN C. WILLIAMS
  • NPI Number: 1881609147
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2220175
LAB Type Pharmacy
Facility Name WALGREENS #07847
Street 524 S SCHOOL AVE
City FAYETTEVILLE
State AR
ZIP 72701
Phone 479 251-1685
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/9/2025
Certificate Expiration Date 4/8/2027
Facility Type Pharmacy
Lab Director KEVIN C. WILLIAMS

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