06D2155984 CLIA NUMBER - WALMART PHARMACY #10-1001

Laboratory Demographics

  • CLIA Code: 06D2155984
  • Facility Name: WALMART PHARMACY #10-1001
  • Facility Address: 4080 W NORTHERN AVE
    PUEBLO, CO
    ZIP 81005
  • Facility Phone: 719 561-0951
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SIMONE M. VIGIL
  • NPI Number: 1568489821
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 06D2155984
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1001
Street 4080 W NORTHERN AVE
City PUEBLO
State CO
ZIP 81005
Phone 719 561-0951
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/9/2024
Certificate Expiration Date 10/8/2026
Facility Type Pharmacy
Lab Director SIMONE M. VIGIL

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