14D2126834 CLIA NUMBER - WALMART PHARMACY 10-0197

Laboratory Demographics

  • CLIA Code: 14D2126834
  • Facility Name: WALMART PHARMACY 10-0197
  • Facility Address: 1730 E JACKSON ST
    MACOMB, IL
    ZIP 61455
  • Facility Phone: 309 833-1456
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA BOURDEN
  • NPI Number: 1447331269
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2126834
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0197
Street 1730 E JACKSON ST
City MACOMB
State IL
ZIP 61455
Phone 309 833-1456
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Pharmacy
Lab Director AMANDA BOURDEN

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