03D2133158 CLIA NUMBER - WALMART PHARMACY 10-2113

Laboratory Demographics

  • CLIA Code: 03D2133158
  • Facility Name: WALMART PHARMACY 10-2113
  • Facility Address: 1607 W BETHANY HOME RD
    PHOENIX, AZ
    ZIP 85015
  • Facility Phone: 602 246-6601
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RAGHAVENDRA SINGH RATHORE
  • NPI Number: 1083631204
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2133158
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2113
Street 1607 W BETHANY HOME RD
City PHOENIX
State AZ
ZIP 85015
Phone 602 246-6601
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Pharmacy
Lab Director RAGHAVENDRA SINGH RATHORE

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