07D2297353 CLIA NUMBER - WALMART #1891

Laboratory Demographics

  • CLIA Code: 07D2297353
  • Facility Name: WALMART #1891
  • Facility Address: 420 BUCKLAND HILL DR
    MANCHESTER, CT
    ZIP 06042
  • Facility Phone: 479 371-2777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAY BERMAN
  • NPI Number: 1417974791
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 07D2297353
LAB Type Pharmacy
Facility Name WALMART #1891
Street 420 BUCKLAND HILL DR
City MANCHESTER
State CT
ZIP 06042
Phone 479 371-2777
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/16/2024
Certificate Expiration Date 1/15/2026
Facility Type Pharmacy
Lab Director JAY BERMAN

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