03D2158031 CLIA NUMBER - WALMART PHARMACY 10-4252

Laboratory Demographics

  • CLIA Code: 03D2158031
  • Facility Name: WALMART PHARMACY 10-4252
  • Facility Address: 2601 E HUNTINGTON DR
    FLAGSTAFF, AZ
    ZIP 86004
  • Facility Phone: 928 774-3419
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN RENOUD
  • NPI Number: 1831406891
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 03D2158031
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4252
Street 2601 E HUNTINGTON DR
City FLAGSTAFF
State AZ
ZIP 86004
Phone 928 774-3419
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 BRIAN RENOUD

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