13D2149827 CLIA NUMBER - WALMART PHARMACY #10-1878

Laboratory Demographics

  • CLIA Code: 13D2149827
  • Facility Name: WALMART PHARMACY #10-1878
  • Facility Address: 1450 NORTH 2ND EAST
    REXBURG, ID
    ZIP 83440
  • Facility Phone: 208 359-2814
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JAROM B. FOGLE
  • NPI Number: 1992722243
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2149827
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1878
Street 1450 NORTH 2ND EAST
City REXBURG
State ID
ZIP 83440
Phone 208 359-2814
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/12/2024
Certificate Expiration Date 6/11/2026
Facility Type Pharmacy
Lab Director JAROM B. FOGLE

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