04D2230002 CLIA NUMBER - WALGREENS #15852

Laboratory Demographics

  • CLIA Code: 04D2230002
  • Facility Name: WALGREENS #15852
  • Facility Address: 1328 RED WOLF BLVD
    JONESBORO, AR
    ZIP 72401
  • Facility Phone: 870 935-2242
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WENDY M. JORDAN
  • NPI Number: 1710060124
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2230002
LAB Type Pharmacy
Facility Name WALGREENS #15852
Street 1328 RED WOLF BLVD
City JONESBORO
State AR
ZIP 72401
Phone 870 935-2242
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/19/2025
Certificate Expiration Date 7/18/2027
Facility Type Pharmacy
Lab Director WENDY M. JORDAN

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