04D2290910 CLIA NUMBER - WALGREENS 02364

Laboratory Demographics

  • CLIA Code: 04D2290910
  • Facility Name: WALGREENS 02364
  • Facility Address: 819 W MAIN ST
    JACKSONVILLE, AR
    ZIP 72076
  • Facility Phone: 501 241-0225
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KIZZY ELLIOTT
  • NPI Number: 1790790061
  • Taxonomy: 333600000X - Pharmacy

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 04D2290910
LAB Type Pharmacy
Facility Name WALGREENS 02364
Street 819 W MAIN ST
City JACKSONVILLE
State AR
ZIP 72076
Phone 501 241-0225
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/3/2025
Certificate Expiration Date 10/2/2027
Facility Type Pharmacy
Lab Director KIZZY ELLIOTT

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