01D2163379 CLIA NUMBER - WALMART PHARMACY 10-394

Laboratory Demographics

  • CLIA Code: 01D2163379
  • Facility Name: WALMART PHARMACY 10-394
  • Facility Address: 15445 HIGHWAY 24
    MOULTON, AL
    ZIP 35650
  • Facility Phone: 256 974-1597
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY HALBROOKS
  • NPI Number: 1891713210
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 01D2163379
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-394
Street 15445 HIGHWAY 24
City MOULTON
State AL
ZIP 35650
Phone 256 974-1597
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/13/2025
Certificate Expiration Date 3/12/2027
Facility Type Pharmacy
Lab Director TRACY HALBROOKS

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