03D2134950 CLIA NUMBER - WALMART PHARMACY 10-5124

Laboratory Demographics

  • CLIA Code: 03D2134950
  • Facility Name: WALMART PHARMACY 10-5124
  • Facility Address: 5605 W NORTHERN AVE
    GLENDALE, AZ
    ZIP 85301
  • Facility Phone: 623 934-7926
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIWATA M. PEREZ
  • NPI Number: 1326065541
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2134950
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5124
Street 5605 W NORTHERN AVE
City GLENDALE
State AZ
ZIP 85301
Phone 623 934-7926
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/11/2025
Certificate Expiration Date 8/10/2027
Facility Type Pharmacy
Lab Director DIWATA M. PEREZ

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