14D2139810 CLIA NUMBER - WALMART PHARMACY 10-1093

Laboratory Demographics

  • CLIA Code: 14D2139810
  • Facility Name: WALMART PHARMACY 10-1093
  • Facility Address: 845 BROADMEADOW RD
    RANTOUL, IL
    ZIP 61866
  • Facility Phone: 217 892-9171
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KRYSTAL L. FRERICHS
  • NPI Number: 1093911927
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139810
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1093
Street 845 BROADMEADOW RD
City RANTOUL
State IL
ZIP 61866
Phone 217 892-9171
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 KRYSTAL L. FRERICHS

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