13D2150900 CLIA NUMBER - WALMART PHARMACY #2831

Laboratory Demographics

  • CLIA Code: 13D2150900
  • Facility Name: WALMART PHARMACY #2831
  • Facility Address: 2680 S LINCOLN AVE
    JEROME, ID
    ZIP 83338
  • Facility Phone: 208 324-4700
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LEXA M. BALLING
  • NPI Number: 1700803053
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 13D2150900
LAB Type Pharmacy
Facility Name WALMART PHARMACY #2831
Street 2680 S LINCOLN AVE
City JEROME
State ID
ZIP 83338
Phone 208 324-4700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/6/2024
Certificate Expiration Date 7/5/2026
Facility Type Pharmacy
Lab Director LEXA M. BALLING

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