03D2126609 CLIA NUMBER - WALMART PHARMACY 10-5429

Laboratory Demographics

  • CLIA Code: 03D2126609
  • Facility Name: WALMART PHARMACY 10-5429
  • Facility Address: 14111 N PRASADA GATEWAY AVE
    SURPRISE, AZ
    ZIP 85388
  • Facility Phone: 623 282-3215
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: PRESTON FULTON
  • NPI Number: 1619240439
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2126609
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5429
Street 14111 N PRASADA GATEWAY AVE
City SURPRISE
State AZ
ZIP 85388
Phone 623 282-3215
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/1/2025
Certificate Expiration Date 2/28/2027
Facility Type Pharmacy
Lab Director PRESTON FULTON

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This page was last updated on: 6/4/2025