03D2157963 CLIA NUMBER - WALMART PHARMACY 10-1240

Laboratory Demographics

  • CLIA Code: 03D2157963
  • Facility Name: WALMART PHARMACY 10-1240
  • Facility Address: 500 N HIGHWAY 90 BYP
    SIERRA VISTA, AZ
    ZIP 85635
  • Facility Phone: 520 458-9690
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA COLISTRO
  • NPI Number: 1265459473
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2157963
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1240
Street 500 N HIGHWAY 90 BYP
City SIERRA VISTA
State AZ
ZIP 85635
Phone 520 458-9690
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/16/2024
Certificate Expiration Date 11/15/2026
Facility Type Pharmacy
Lab Director AMANDA COLISTRO

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