13D2149848 CLIA NUMBER - WALMART PHARMACY #10-2782

Laboratory Demographics

  • CLIA Code: 13D2149848
  • Facility Name: WALMART PHARMACY #10-2782
  • Facility Address: 2745 AMERICAN LEGION BLVD
    MOUNTAIN HOME, ID
    ZIP 83647
  • Facility Phone: 208 587-0861
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARLENA A. AUSTIN
  • NPI Number: 1891712147
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2149848
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-2782
Street 2745 AMERICAN LEGION BLVD
City MOUNTAIN HOME
State ID
ZIP 83647
Phone 208 587-0861
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 MARLENA A. AUSTIN

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