13D2149840 CLIA NUMBER - WALMART PHARMACY #10-1902

Laboratory Demographics

  • CLIA Code: 13D2149840
  • Facility Name: WALMART PHARMACY #10-1902
  • Facility Address: 1201 S 25TH E
    AMMON, ID
    ZIP 83406
  • Facility Phone: 208 522-2866
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BRIAN C. CHRISTENSON PHARM D
  • NPI Number: 1629095971
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2149840
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-1902
Street 1201 S 25TH E
City AMMON
State ID
ZIP 83406
Phone 208 522-2866
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 BRIAN C. CHRISTENSON PHARM D

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