01D2158421 CLIA NUMBER - WALMART PHARMACY 10-1620

Laboratory Demographics

  • CLIA Code: 01D2158421
  • Facility Name: WALMART PHARMACY 10-1620
  • Facility Address: 2578 DOUGLAS AVE
    BREWTON, AL
    ZIP 36426
  • Facility Phone: 251 867-5358
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MR. MARK W. JACKSON
  • NPI Number: 1992722292
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2158421
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1620
Street 2578 DOUGLAS AVE
City BREWTON
State AL
ZIP 36426
Phone 251 867-5358
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/28/2024
Certificate Expiration Date 11/27/2026
Facility Type Pharmacy
Lab Director MR. MARK W. JACKSON

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