14D2139809 CLIA NUMBER - WALMART PHARMACY 10-0200

Laboratory Demographics

  • CLIA Code: 14D2139809
  • Facility Name: WALMART PHARMACY 10-0200
  • Facility Address: 1941 W MORTON AVE
    JACKSONVILLE, IL
    ZIP 62650
  • Facility Phone: 217 245-5815
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: DANIEL W. VANMETER
  • NPI Number: 1336318021
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2139809
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0200
Street 1941 W MORTON AVE
City JACKSONVILLE
State IL
ZIP 62650
Phone 217 245-5815
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Pharmacy
Lab Director DANIEL W. VANMETER

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