03D2158702 CLIA NUMBER - WALMART PHARMACY 10-4203

Laboratory Demographics

CLIA Number: 03D2158702

Facility Name: WALMART PHARMACY 10-4203

Facility Address:
5210 S HWY 95
FORT MOHAVE, AZ
ZIP 86426
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Facility Phone Number: 928 768-9022

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1730628728

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	03D2158702
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-4203
Street	5210 S HWY 95
City	FORT MOHAVE
State	AZ
ZIP	86426
Phone	928 768-9022
CertificateType	4
CertificateEffectiveDate	12/4/2022
CertificateExpirationDate	12/3/2024
FacilityType	Waiver

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