04D2275363 CLIA NUMBER - WILSON BEARDEN PHARMACY

Laboratory Demographics

  • CLIA Code: 04D2275363
  • Facility Name: WILSON BEARDEN PHARMACY
  • Facility Address: 134 N WASHINGTON
    MAGNOLIA, AR
    ZIP 71753
  • Facility Phone: 870 234-1062
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IVY MOORE
  • NPI Number: 1174534705
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2275363
LAB Type Pharmacy
Facility Name WILSON BEARDEN PHARMACY
Street 134 N WASHINGTON
City MAGNOLIA
State AR
ZIP 71753
Phone 870 234-1062
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Pharmacy
Lab Director IVY MOORE

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