13D2149866 CLIA NUMBER - WALMART PHARMACY #10-5494

Laboratory Demographics

  • CLIA Code: 13D2149866
  • Facility Name: WALMART PHARMACY #10-5494
  • Facility Address: 500 S UTAH AVE
    IDAHO FALLS, ID
    ZIP 83402
  • Facility Phone: 208 528-8703
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ROBERT A. BLUE
  • NPI Number: 1255358503
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2149866
LAB Type Pharmacy
Facility Name WALMART PHARMACY #10-5494
Street 500 S UTAH AVE
City IDAHO FALLS
State ID
ZIP 83402
Phone 208 528-8703
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 ROBERT A. BLUE

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