14D2126837 CLIA NUMBER - WALMART PHARMACY 10-0262

Laboratory Demographics

  • CLIA Code: 14D2126837
  • Facility Name: WALMART PHARMACY 10-0262
  • Facility Address: 919 GIACONE DR
    BENTON, IL
    ZIP 62812
  • Facility Phone: 618 435-2119
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: NICOLE L. MCBRIDE
  • NPI Number: 1356455315
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2126837
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0262
Street 919 GIACONE DR
City BENTON
State IL
ZIP 62812
Phone 618 435-2119
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 NICOLE L. MCBRIDE

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