14D2139812 CLIA NUMBER - WAL-MART PHARMACY 1420

Laboratory Demographics

  • CLIA Code: 14D2139812
  • Facility Name: WAL-MART PHARMACY 1420
  • Facility Address: 850 S BARRINGSTON RD
    STREAMWOOD, IL
    ZIP 60107
  • Facility Phone: 630 213-7199
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA M. ELLISON
  • NPI Number: 1831408160
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139812
LAB Type Pharmacy
Facility Name WAL-MART PHARMACY 1420
Street 850 S BARRINGSTON RD
City STREAMWOOD
State IL
ZIP 60107
Phone 630 213-7199
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 AMANDA M. ELLISON

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