14D2133024 CLIA NUMBER - WALMART PHARMACY 10-5199

Laboratory Demographics

  • CLIA Code: 14D2133024
  • Facility Name: WALMART PHARMACY 10-5199
  • Facility Address: 475 EAST ROUTE 173
    ANTIOCH, IL
    ZIP 60002
  • Facility Phone: 847 838-3184
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JUSTIN T. COLEMAN
  • NPI Number: 1417032715
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2133024
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5199
Street 475 EAST ROUTE 173
City ANTIOCH
State IL
ZIP 60002
Phone 847 838-3184
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 JUSTIN T. COLEMAN

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