13D2136339 CLIA NUMBER - WALMART PHARMACY 10-1995

Laboratory Demographics

  • CLIA Code: 13D2136339
  • Facility Name: WALMART PHARMACY 10-1995
  • Facility Address: 4240 YELLOWSTONE AVE
    CHUBBUCK, ID
    ZIP 83202
  • Facility Phone: 208 237-5091
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WILLIAM JORDAN
  • NPI Number: 1447277793
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2136339
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1995
Street 4240 YELLOWSTONE AVE
City CHUBBUCK
State ID
ZIP 83202
Phone 208 237-5091
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/7/2025
Certificate Expiration Date 9/6/2027
Facility Type Pharmacy
Lab Director WILLIAM JORDAN

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