14D2120970 CLIA NUMBER - WAL-MART PHARMACY #10-1125 WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 14D2120970
  • Facility Name: WAL-MART PHARMACY #10-1125 WAL-MART STORES EAST LP
  • Facility Address: 300 GREENBRIAR DR
    NORMAL, IL
    ZIP 61761
  • Facility Phone: (479) 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VALERIE KOCH
  • NPI Number: 1619994985
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2120970
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-1125 WAL-MART STORES EAST LP
Street 300 GREENBRIAR DR
City NORMAL
State IL
ZIP 61761
Phone 4792587034
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 VALERIE KOCH

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This page was last updated on: 5/15/2026