07D2297372 CLIA NUMBER - WALMART #5777

Laboratory Demographics

  • CLIA Code: 07D2297372
  • Facility Name: WALMART #5777
  • Facility Address: 450 PROVIDENCE RD
    BROOKLYN, CT
    ZIP 06234
  • Facility Phone: 479 371-2777
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSE OWEN
  • NPI Number: 1710312574
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 07D2297372
LAB Type Pharmacy
Facility Name WALMART #5777
Street 450 PROVIDENCE RD
City BROOKLYN
State CT
ZIP 06234
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 JESSE OWEN

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