03D2157985 CLIA NUMBER - WALMART PHARMACY 10-1417

Laboratory Demographics

  • CLIA Code: 03D2157985
  • Facility Name: WALMART PHARMACY 10-1417
  • Facility Address: 3050 E STATE ROUTE 69
    PRESCOTT, AZ
    ZIP 86301
  • Facility Phone: 928 445-3020
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHAEEUN IRENE LIM
  • NPI Number: 1396512059
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 03D2157985
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1417
Street 3050 E STATE ROUTE 69
City PRESCOTT
State AZ
ZIP 86301
Phone 928 445-3020
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/19/2024
Certificate Expiration Date 11/18/2026
Facility Type Pharmacy
Lab Director CHAEEUN IRENE LIM

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