14D2139571 CLIA NUMBER - WALMART PHARMACY 10-5398

Laboratory Demographics

  • CLIA Code: 14D2139571
  • Facility Name: WALMART PHARMACY 10-5398
  • Facility Address: 3902 W RIVERSIDE BLVD
    ROCKFORD, IL
    ZIP 61101
  • Facility Phone: 815 962-4763
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: WHITNEY BENNETT
  • NPI Number: 1063595643
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139571
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-5398
Street 3902 W RIVERSIDE BLVD
City ROCKFORD
State IL
ZIP 61101
Phone 815 962-4763
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 WHITNEY BENNETT

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