04D2311458 CLIA NUMBER - WALDEN DRUG

Laboratory Demographics

  • CLIA Code: 04D2311458
  • Facility Name: WALDEN DRUG
  • Facility Address: 3104 W KINGSHIGHWAY
    PARAGOULD, AR
    ZIP 72450
  • Facility Phone: 870 236-6118
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEREMY A. HANCOCK
  • NPI Number: 1073601571
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2311458
LAB Type Pharmacy
Facility Name WALDEN DRUG
Street 3104 W KINGSHIGHWAY
City PARAGOULD
State AR
ZIP 72450
Phone 870 236-6118
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/23/2024
Certificate Expiration Date 9/22/2026
Facility Type Pharmacy
Lab Director JEREMY A. HANCOCK

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