14D2121066 CLIA NUMBER - WAL-MART PHARMACY #10-1071

Laboratory Demographics

  • CLIA Code: 14D2121066
  • Facility Name: WAL-MART PHARMACY #10-1071
  • Facility Address: 610 WESLEY DR
    WOOD RIVER, IL
    ZIP 62095
  • Facility Phone: 479 258-7034
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: CHRIS HURTTE
  • NPI Number: 1891712162
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2121066
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY #10-1071
Street 610 WESLEY DR
City WOOD RIVER
State IL
ZIP 62095
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 10/28/2024
Certificate Expiration Date 10/27/2026
Facility Type Pharmacy
Lab Director CHRIS HURTTE

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