14D2121065 CLIA NUMBER - WAL-MART PHARMACY #10-0199

Laboratory Demographics

  • CLIA Code: 14D2121065
  • Facility Name: WAL-MART PHARMACY #10-0199
  • Facility Address: 825 MALERICH DR
    LINCOLN, IL
    ZIP 62656
  • Facility Phone: 309 657-0303
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: LAURA ANN DICKEY
  • NPI Number: 1295752566
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2121065
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-0199
Street 825 MALERICH DR
City LINCOLN
State IL
ZIP 62656
Phone 309 657-0303
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Pharmacy
Lab Director LAURA ANN DICKEY

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