14D2139381 CLIA NUMBER - WAL-MART PHARMACY 480

Laboratory Demographics

  • CLIA Code: 14D2139381
  • Facility Name: WAL-MART PHARMACY 480
  • Facility Address: 151 SHETLAND DR
    PITTSFIELD, IL
    ZIP 62363
  • Facility Phone: 217 285-9709
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: SCHUYLER M. SPANN
  • NPI Number: 1407939085
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139381
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY 480
Street 151 SHETLAND DR
City PITTSFIELD
State IL
ZIP 62363
Phone 217 285-9709
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 SCHUYLER M. SPANN

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