04D2288704 CLIA NUMBER - WALGREENS 15797

Laboratory Demographics

  • CLIA Code: 04D2288704
  • Facility Name: WALGREENS 15797
  • Facility Address: 1125 W 2ND ST
    WALDRON, AR
    ZIP 72958
  • Facility Phone: 479 637-4197
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHARLES R. CARNATION
  • NPI Number: 1396878468
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2288704
LAB Type Pharmacy
Facility Name WALGREENS 15797
Street 1125 W 2ND ST
City WALDRON
State AR
ZIP 72958
Phone 479 637-4197
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/29/2025
Certificate Expiration Date 8/28/2027
Facility Type Pharmacy
Lab Director CHARLES R. CARNATION

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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