14D2120967 CLIA NUMBER - WAL-MART PHARMACY #10-0256 WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 14D2120967
  • Facility Name: WAL-MART PHARMACY #10-0256 WAL-MART STORES EAST LP
  • Facility Address: 400 JUNCTION DR
    GLEN CARBON, IL
    ZIP 62034
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ERIC HESS
  • NPI Number: 1598782880
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2120967
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-0256 WAL-MART STORES EAST LP
Street 400 JUNCTION DR
City GLEN CARBON
State IL
ZIP 62034
Phone 479 258-7034
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 ERIC HESS

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