14D2139546 CLIA NUMBER - WALMART PHARMACY 10-1602

Laboratory Demographics

  • CLIA Code: 14D2139546
  • Facility Name: WALMART PHARMACY 10-1602
  • Facility Address: 3401 FREEDOM DRIVE
    SPRINGFIELD, IL
    ZIP 62704
  • Facility Phone: 217 793-3368
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DIANE M. MATTIUZ
  • NPI Number: 1326129347
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139546
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1602
Street 3401 FREEDOM DRIVE
City SPRINGFIELD
State IL
ZIP 62704
Phone 217 793-3368
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/6/2023
Certificate Expiration Date 11/5/2025
Facility Type Pharmacy
Lab Director DIANE M. MATTIUZ

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