14D2133020 CLIA NUMBER - WALMART 5617

Laboratory Demographics

  • CLIA Code: 14D2133020
  • Facility Name: WALMART 5617
  • Facility Address: 4626 W DIVERSEY AVE
    CHICAGO, IL
    ZIP 60639
  • Facility Phone: 773 628-1883
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JESSICA M. PARENT
  • NPI Number: 1780782276
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2133020
LAB Type Pharmacy
Facility Name WALMART 5617
Street 4626 W DIVERSEY AVE
City CHICAGO
State IL
ZIP 60639
Phone 773 628-1883
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 7/3/2025
Certificate Expiration Date 7/2/2027
Facility Type Pharmacy
Lab Director JESSICA M. PARENT

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