14D2127436 CLIA NUMBER - WALMART PHARMACY 10-1553

Laboratory Demographics

CLIA Number: 14D2127436

Facility Name: WALMART PHARMACY 10-1553

Facility Address:
314 WEST ARMY TRAIL ROAD
BLOOMINGDALE, IL
ZIP 60108
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Facility Phone Number: 630 893-5382

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1700219474

Taxonomy: 332H00000X - Eyewear Supplier
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

CLIA Record

Field Name	Field Value
CLIA Number	14D2127436
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-1553
Street	314 WEST ARMY TRAIL ROAD
City	BLOOMINGDALE
State	IL
ZIP	60108
Phone	630 893-5382
CertificateType	4
CertificateEffectiveDate	3/14/2023
CertificateExpirationDate	3/13/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024