04D2318282 CLIA NUMBER - WALGREENS #21547

Laboratory Demographics

  • CLIA Code: 04D2318282
  • Facility Name: WALGREENS #21547
  • Facility Address: 2800 SOUTH HAZEL STREET
    PINE BLUFF, AR
    ZIP 71603
  • Facility Phone: 870 535-4044
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MELISSA M. HOLLEY
  • NPI Number: 1629755442
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 04D2318282
LAB Type Pharmacy
Facility Name WALGREENS #21547
Street 2800 SOUTH HAZEL STREET
City PINE BLUFF
State AR
ZIP 71603
Phone 870 535-4044
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/7/2025
Certificate Expiration Date 2/6/2027
Facility Type Pharmacy
Lab Director MELISSA M. HOLLEY

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