03D2158038 CLIA NUMBER - WALMART PHARMACY 10-5303

Laboratory Demographics

  • CLIA Code: 03D2158038
  • Facility Name: WALMART PHARMACY 10-5303
  • Facility Address: 1280 GAIL GARDNER WAY
    PRESCOTT, AZ
    ZIP 86305
  • Facility Phone: 928 541-0562
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KELEE ESQUIVEL
  • NPI Number: 1891871091
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 03D2158038
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5303
Street 1280 GAIL GARDNER WAY
City PRESCOTT
State AZ
ZIP 86305
Phone 928 541-0562
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 KELEE ESQUIVEL

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