14D2139407 CLIA NUMBER - WALMART PHARMACY 10-0636

Laboratory Demographics

  • CLIA Code: 14D2139407
  • Facility Name: WALMART PHARMACY 10-0636
  • Facility Address: 2111 CLAUDE BAILEY PKWY
    PRINCETON, IL
    ZIP 61356
  • Facility Phone: 815 875-4551
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK A. GUALANDRI
  • NPI Number: 1295816189
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139407
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0636
Street 2111 CLAUDE BAILEY PKWY
City PRINCETON
State IL
ZIP 61356
Phone 815 875-4551
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 MARK A. GUALANDRI

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