14D2120964 CLIA NUMBER - WAL-MART PHARMACY #10-5157

Laboratory Demographics

  • CLIA Code: 14D2120964
  • Facility Name: WAL-MART PHARMACY #10-5157
  • Facility Address: 155 E COURTLAND ST
    MORTON, IL
    ZIP 61550
  • Facility Phone: 309 263-6728
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSICA OLSON
  • NPI Number: 1588681886
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2120964
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-5157
Street 155 E COURTLAND ST
City MORTON
State IL
ZIP 61550
Phone 309 263-6728
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Pharmacy
Lab Director JESSICA OLSON

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