04D2244017 CLIA NUMBER - WALGREENS #11988

Laboratory Demographics

  • CLIA Code: 04D2244017
  • Facility Name: WALGREENS #11988
  • Facility Address: 2750 E MISSION BLVD
    FAYETTEVILLE, AR
    ZIP 72703
  • Facility Phone: 479 442-2134
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM POWERS
  • NPI Number: 1902052285
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2244017
LAB Type Pharmacy
Facility Name WALGREENS #11988
Street 2750 E MISSION BLVD
City FAYETTEVILLE
State AR
ZIP 72703
Phone 479 442-2134
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/24/2023
Certificate Expiration Date 11/23/2025
Facility Type Pharmacy
Lab Director WILLIAM POWERS

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