04D2223219 CLIA NUMBER - WALGREENS #12417

Laboratory Demographics

  • CLIA Code: 04D2223219
  • Facility Name: WALGREENS #12417
  • Facility Address: 1045 S SAINT LOUIS ST
    BATESVILLE, AR
    ZIP 72501
  • Facility Phone: 870 307-0262
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BLAKE MOORE
  • NPI Number: 1083855605
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2223219
LAB Type Pharmacy
Facility Name WALGREENS #12417
Street 1045 S SAINT LOUIS ST
City BATESVILLE
State AR
ZIP 72501
Phone 870 307-0262
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/5/2025
Certificate Expiration Date 5/4/2027
Facility Type Pharmacy
Lab Director BLAKE MOORE

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