14D2139559 CLIA NUMBER - WALMART PHARMACY 10-2817

Laboratory Demographics

  • CLIA Code: 14D2139559
  • Facility Name: WALMART PHARMACY 10-2817
  • Facility Address: 17625 TORRENCE AVE
    LANSING, IL
    ZIP 60438
  • Facility Phone: 708 474-9234
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: REGINA ITTEERA
  • NPI Number: 1235212770
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139559
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-2817
Street 17625 TORRENCE AVE
City LANSING
State IL
ZIP 60438
Phone 708 474-9234
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 REGINA ITTEERA

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