03D2133152 CLIA NUMBER - WALMART PHARMACY 10-1549

Laboratory Demographics

  • CLIA Code: 03D2133152
  • Facility Name: WALMART PHARMACY 10-1549
  • Facility Address: 2020 N 75TH AVE
    PHOENIX, AZ
    ZIP 85035
  • Facility Phone: 623 849-4055
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACKELLYN V. REEVES
  • NPI Number: 1245257450
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2133152
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1549
Street 2020 N 75TH AVE
City PHOENIX
State AZ
ZIP 85035
Phone 623 849-4055
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2023
Certificate Expiration Date 7/5/2025
Facility Type Pharmacy
Lab Director JACKELLYN V. REEVES

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