14D2139377 CLIA NUMBER - WALMART PHARMACY 10-0224

Laboratory Demographics

  • CLIA Code: 14D2139377
  • Facility Name: WALMART PHARMACY 10-0224
  • Facility Address: 110 DAVIDSON RD
    MOUNT VERNON, IL
    ZIP 62864
  • Facility Phone: 618 244-0735
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JASON K. STEINKAMP
  • NPI Number: 1801977913
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139377
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0224
Street 110 DAVIDSON RD
City MOUNT VERNON
State IL
ZIP 62864
Phone 618 244-0735
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 JASON K. STEINKAMP

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