14D2139811 CLIA NUMBER - WALMART PHARMACY 10-1413

Laboratory Demographics

  • CLIA Code: 14D2139811
  • Facility Name: WALMART PHARMACY 10-1413
  • Facility Address: 1205 S IL ROUTE 31
    CRYSTAL LAKE, IL
    ZIP 60014
  • Facility Phone: 815 455-4409
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: MARK ANDREW VIERKE
  • NPI Number: 1326229253
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2139811
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1413
Street 1205 S IL ROUTE 31
City CRYSTAL LAKE
State IL
ZIP 60014
Phone 815 455-4409
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 MARK ANDREW VIERKE

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