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03D2134951 CLIA NUMBER - WALMART PHARMACY 10-2554

Laboratory Demographics

CLIA Number: 03D2134951

Facility Name: WALMART PHARMACY 10-2554

Facility Address:
13055 W RANCHO SANTA FE BLVD
AVONDALE, AZ
ZIP 85392
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Facility Phone Number: 623 935-4022

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1619994837

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name Field Value
CLIA Number 03D2134951
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2554
Street 13055 W RANCHO SANTA FE BLVD
City AVONDALE
State AZ
ZIP 85392
Phone 623 935-4022
CertificateType 4
CertificateEffectiveDate 8/11/2023
CertificateExpirationDate 8/10/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024