04D2309483 CLIA NUMBER - WALGREENS 21511

Laboratory Demographics

  • CLIA Code: 04D2309483
  • Facility Name: WALGREENS 21511
  • Facility Address: 1600 DR MARTIN LUTHER KING JR DRIVE
    CROSSETT, AR
    ZIP 71635
  • Facility Phone: 870 364-8220
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ASHLEIGH WARD
  • NPI Number: 1407532732
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2309483
LAB Type Pharmacy
Facility Name WALGREENS 21511
Street 1600 DR MARTIN LUTHER KING JR DRIVE
City CROSSETT
State AR
ZIP 71635
Phone 870 364-8220
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/15/2024
Certificate Expiration Date 8/14/2026
Facility Type Pharmacy
Lab Director ASHLEIGH WARD

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