14D2131887 CLIA NUMBER - WALMART PHARMACY 10-1596

Laboratory Demographics

  • CLIA Code: 14D2131887
  • Facility Name: WALMART PHARMACY 10-1596
  • Facility Address: 200 S BOLINGBROOK DR
    BOLINGBROOK, IL
    ZIP 60440
  • Facility Phone: 630 739-4883
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: VICTOR M. VAZQUEZ
  • NPI Number: 1669554572
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2131887
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1596
Street 200 S BOLINGBROOK DR
City BOLINGBROOK
State IL
ZIP 60440
Phone 630 739-4883
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/7/2025
Certificate Expiration Date 6/6/2027
Facility Type Pharmacy
Lab Director VICTOR M. VAZQUEZ

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