14D2138494 CLIA NUMBER - WALMART PHARMACY 10-0361

Laboratory Demographics

  • CLIA Code: 14D2138494
  • Facility Name: WALMART PHARMACY 10-0361
  • Facility Address: 1040 COLLINSVILLE CROSSING BLVD
    COLLINSVILLE, IL
    ZIP 62234
  • Facility Phone: 618 344-7112
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN LUITJOHAN
  • NPI Number: 1255865853
  • Taxonomy: 333600000X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2138494
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0361
Street 1040 COLLINSVILLE CROSSING BLVD
City COLLINSVILLE
State IL
ZIP 62234
Phone 618 344-7112
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/18/2025
Certificate Expiration Date 10/17/2027
Facility Type Pharmacy
Lab Director KEVIN LUITJOHAN

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