14D2126845 CLIA NUMBER - WALMART PHARMACY 10-0216

Laboratory Demographics

  • CLIA Code: 14D2126845
  • Facility Name: WALMART PHARMACY 10-0216
  • Facility Address: 2802 OUTER ROAD DR
    MARION, IL
    ZIP 62959
  • Facility Phone: 618 997-2021
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MACY RUSSEL-TAYLOR
  • NPI Number: 1871756239
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2126845
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0216
Street 2802 OUTER ROAD DR
City MARION
State IL
ZIP 62959
Phone 618 997-2021
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 MACY RUSSEL-TAYLOR

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