14D2139835 CLIA NUMBER - WALMART PHARMACY 10-1454

Laboratory Demographics

  • CLIA Code: 14D2139835
  • Facility Name: WALMART PHARMACY 10-1454
  • Facility Address: 5211 BROADWAY ST
    QUINCY, IL
    ZIP 62305
  • Facility Phone: 217 228-2331
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANDREW J. DUNHAM
  • NPI Number: 1871674994
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139835
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1454
Street 5211 BROADWAY ST
City QUINCY
State IL
ZIP 62305
Phone 217 228-2331
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 ANDREW J. DUNHAM

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