14D2117456 CLIA NUMBER - WAL-MART PHARMACY #10-5965

Laboratory Demographics

  • CLIA Code: 14D2117456
  • Facility Name: WAL-MART PHARMACY #10-5965
  • Facility Address: 10900 S DOTY AVE
    CHICAGO, IL
    ZIP 60628
  • Facility Phone: 773 344-9061
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VICTORIA L. PETRZILKA
  • NPI Number: 1265773386
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2117456
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-5965
Street 10900 S DOTY AVE
City CHICAGO
State IL
ZIP 60628
Phone 773 344-9061
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/16/2024
Certificate Expiration Date 8/15/2026
Facility Type Pharmacy
Lab Director VICTORIA L. PETRZILKA

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