14D2139552 CLIA NUMBER - WALMART PHARMACY 10-2231

Laboratory Demographics

  • CLIA Code: 14D2139552
  • Facility Name: WALMART PHARMACY 10-2231
  • Facility Address: 3930 44TH AVENUE DRIVE
    MOLINE, IL
    ZIP 61265
  • Facility Phone: 309 736-2275
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: TRACY SHEWELL
  • NPI Number: 1639250731
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139552
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2231
Street 3930 44TH AVENUE DRIVE
City MOLINE
State IL
ZIP 61265
Phone 309 736-2275
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 TRACY SHEWELL

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