14D2139844 CLIA NUMBER - WALMART PHARMACY 10-3210

Laboratory Demographics

  • CLIA Code: 14D2139844
  • Facility Name: WALMART PHARMACY 10-3210
  • Facility Address: 2760 NO DIRKSEN PKWY
    SPRINGFIELD, IL
    ZIP 62702
  • Facility Phone: 217 522-4054
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: RIDGE LIN
  • NPI Number: 1407939952
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2139844
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-3210
Street 2760 NO DIRKSEN PKWY
City SPRINGFIELD
State IL
ZIP 62702
Phone 217 522-4054
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 RIDGE LIN

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