14D2139568 CLIA NUMBER - WALMART PHARMACY 10-4641

Laboratory Demographics

  • CLIA Code: 14D2139568
  • Facility Name: WALMART PHARMACY 10-4641
  • Facility Address: 12300 ROUTE 47
    HUNTLEY, IL
    ZIP 60142
  • Facility Phone: 847 669-7563
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JACOB M. FULTON
  • NPI Number: 1669841730
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139568
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-4641
Street 12300 ROUTE 47
City HUNTLEY
State IL
ZIP 60142
Phone 847 669-7563
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 JACOB M. FULTON

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