14D2120972 CLIA NUMBER - WAL-MART PHARMACY #10-2956 WAL-MART STORES EAST LP

Laboratory Demographics

  • CLIA Code: 14D2120972
  • Facility Name: WAL-MART PHARMACY #10-2956 WAL-MART STORES EAST LP
  • Facility Address: 1401 IL ROUTE 59
    SHOREWOOD, IL
    ZIP 60431
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MICHELLE L. EWING
  • NPI Number: 1679590970
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2120972
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-2956 WAL-MART STORES EAST LP
Street 1401 IL ROUTE 59
City SHOREWOOD
State IL
ZIP 60431
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 MICHELLE L. EWING

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