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03D2158033 CLIA NUMBER - WALMART PHARMACY 10-4355

Laboratory Demographics

CLIA Number: 03D2158033

Facility Name: WALMART PHARMACY 10-4355

Facility Address:
715 N MAIN STREET
TAYLOR, AZ
ZIP 85939
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Facility Phone Number: 928 536-6885

Facility Type: Pharmacy

Certificate Type: Waiver
NPI Number: 1639538937

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name Field Value
CLIA Number 03D2158033
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4355
Street 715 N MAIN STREET
City TAYLOR
State AZ
ZIP 85939
Phone 928 536-6885
CertificateType 4
CertificateEffectiveDate 11/19/2022
CertificateExpirationDate 11/18/2024
FacilityType Waiver

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