14D2140319 CLIA NUMBER - WALMART PHARMACY 10-0253

Laboratory Demographics

  • CLIA Code: 14D2140319
  • Facility Name: WALMART PHARMACY 10-0253
  • Facility Address: 1316 S STATE ST
    JERSEYVILLE, IL
    ZIP 62052
  • Facility Phone: 618 498-6864
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA K. CRANE
  • NPI Number: 1689755415
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2140319
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0253
Street 1316 S STATE ST
City JERSEYVILLE
State IL
ZIP 62052
Phone 618 498-6864
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/20/2023
Certificate Expiration Date 11/19/2025
Facility Type Pharmacy
Lab Director AMANDA K. CRANE

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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