04D2230011 CLIA NUMBER - WALGREENS #16021

Laboratory Demographics

  • CLIA Code: 04D2230011
  • Facility Name: WALGREENS #16021
  • Facility Address: 1311 S WALTON BLVD
    BENTONVILLE, AR
    ZIP 72712
  • Facility Phone: 479 268-7979
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIN E. DERKS
  • NPI Number: 1831599489
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2230011
LAB Type Pharmacy
Facility Name WALGREENS #16021
Street 1311 S WALTON BLVD
City BENTONVILLE
State AR
ZIP 72712
Phone 479 268-7979
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 ERIN E. DERKS

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