01D2158959 CLIA NUMBER - WALMART PHARMACY 10-691

Laboratory Demographics

  • CLIA Code: 01D2158959
  • Facility Name: WALMART PHARMACY 10-691
  • Facility Address: 2001 GLENN BLVD SW
    FORT PAYNE, AL
    ZIP 35968
  • Facility Phone: 256 997-1194
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DR. KELSEY MCMILLAN
  • NPI Number: 1720006158
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2158959
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-691
Street 2001 GLENN BLVD SW
City FORT PAYNE
State AL
ZIP 35968
Phone 256 997-1194
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 DR. KELSEY MCMILLAN

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