01D2158951 CLIA NUMBER - WALMART PHARMACY 10-483

Laboratory Demographics

  • CLIA Code: 01D2158951
  • Facility Name: WALMART PHARMACY 10-483
  • Facility Address: 1903 COBBS FORD RD
    PRATTVILLE, AL
    ZIP 36066
  • Facility Phone: 334 365-7774
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VINCENT AZZARELLO
  • NPI Number: 1639196934
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2158951
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-483
Street 1903 COBBS FORD RD
City PRATTVILLE
State AL
ZIP 36066
Phone 334 365-7774
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/11/2024
Certificate Expiration Date 12/10/2026
Facility Type Pharmacy
Lab Director VINCENT AZZARELLO

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