14D2126850 CLIA NUMBER - WALMART PHARMACY 10-2204

Laboratory Demographics

  • CLIA Code: 14D2126850
  • Facility Name: WALMART PHARMACY 10-2204
  • Facility Address: 1300 DES PLAINES AVE
    FOREST PARK, IL
    ZIP 60130
  • Facility Phone: 708 771-2236
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KATHRYN DERAEDT
  • NPI Number: 1508141219
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2126850
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2204
Street 1300 DES PLAINES AVE
City FOREST PARK
State IL
ZIP 60130
Phone 708 771-2236
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 KATHRYN DERAEDT

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