13D2136344 CLIA NUMBER - WALMART PHARMACY 10-3511

Laboratory Demographics

  • CLIA Code: 13D2136344
  • Facility Name: WALMART PHARMACY 10-3511
  • Facility Address: 550 W HONEYSUCKLE AVE
    HAYDEN, ID
    ZIP 83835
  • Facility Phone: 208 209-4081
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KAYLA MIELKE
  • NPI Number: 1730493834
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2136344
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3511
Street 550 W HONEYSUCKLE AVE
City HAYDEN
State ID
ZIP 83835
Phone 208 209-4081
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 KAYLA MIELKE

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