01D2160219 CLIA NUMBER - WALMART PHARMACY 10-2760

Laboratory Demographics

  • CLIA Code: 01D2160219
  • Facility Name: WALMART PHARMACY 10-2760
  • Facility Address: 4206 N COLLEGE AVE
    JACKSON, AL
    ZIP 36545
  • Facility Phone: 251 247-2520
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DEWAYNE SMITH
  • NPI Number: 1538186846
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2160219
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2760
Street 4206 N COLLEGE AVE
City JACKSON
State AL
ZIP 36545
Phone 251 247-2520
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/7/2025
Certificate Expiration Date 1/6/2027
Facility Type Pharmacy
Lab Director DEWAYNE SMITH

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