14D2139375 CLIA NUMBER - WALMART PHARMACY 10-0196

Laboratory Demographics

  • CLIA Code: 14D2139375
  • Facility Name: WALMART PHARMACY 10-0196
  • Facility Address: 1450 E MAIN ST
    CARBONDALE, IL
    ZIP 62901
  • Facility Phone: 618 549-0709
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JULIA BOST
  • NPI Number: 1255414892
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139375
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0196
Street 1450 E MAIN ST
City CARBONDALE
State IL
ZIP 62901
Phone 618 549-0709
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/2/2023
Certificate Expiration Date 11/1/2025
Facility Type Pharmacy
Lab Director JULIA BOST

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