14D2125555 CLIA NUMBER - WAL-MART PHARMACY 10-5403

Laboratory Demographics

  • CLIA Code: 14D2125555
  • Facility Name: WAL-MART PHARMACY 10-5403
  • Facility Address: 100 S HIGH CROSS RD
    URBANA, IL
    ZIP 61802
  • Facility Phone: 217 344-6190
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ALEXANDRIA GOCHENAUER
  • NPI Number: 1669499968
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2125555
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY 10-5403
Street 100 S HIGH CROSS RD
City URBANA
State IL
ZIP 61802
Phone 217 344-6190
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/9/2025
Certificate Expiration Date 2/8/2027
Facility Type Pharmacy
Lab Director ALEXANDRIA GOCHENAUER

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