13D2136346 CLIA NUMBER - WALMART PHARMACY 10-5869

Laboratory Demographics

  • CLIA Code: 13D2136346
  • Facility Name: WALMART PHARMACY 10-5869
  • Facility Address: 2470 W PULLMAN RD 2
    MOSCOW, ID
    ZIP 83843
  • Facility Phone: 208 883-8828
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BERTHA FUTSE PHARM D
  • NPI Number: 1912215534
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 13D2136346
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5869
Street 2470 W PULLMAN RD 2
City MOSCOW
State ID
ZIP 83843
Phone 208 883-8828
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 BERTHA FUTSE PHARM D

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