14D2139402 CLIA NUMBER - WALMART PHARMACY 1681

Laboratory Demographics

  • CLIA Code: 14D2139402
  • Facility Name: WALMART PHARMACY 1681
  • Facility Address: 930 E MT PROSPECT PLAZA
    MT PROSPECT, IL
    ZIP 60056
  • Facility Phone: 847 590-0011
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BAKER YASEEN
  • NPI Number: 1962429241
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2139402
LAB Type Pharmacy
Facility Name WALMART PHARMACY 1681
Street 930 E MT PROSPECT PLAZA
City MT PROSPECT
State IL
ZIP 60056
Phone 847 590-0011
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 BAKER YASEEN

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