03D2117154 CLIA NUMBER - WALMART PHARMACY #10-3771

Laboratory Demographics

  • CLIA Code: 03D2117154
  • Facility Name: WALMART PHARMACY #10-3771
  • Facility Address: 6150 S 35TH AVE
    PHOENIX, AZ
    ZIP 85041
  • Facility Phone: 602 243-8517
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: IAN IVANCIC
  • NPI Number: 1275696361
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 03D2117154
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-3771
Street 6150 S 35TH AVE
City PHOENIX
State AZ
ZIP 85041
Phone 602 243-8517
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/9/2024
Certificate Expiration Date 8/8/2026
Facility Type Pharmacy
Lab Director IAN IVANCIC

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