14D2140320 CLIA NUMBER - WALMART PHARMACY 10-0252

Laboratory Demographics

  • CLIA Code: 14D2140320
  • Facility Name: WALMART PHARMACY 10-0252
  • Facility Address: 215 E GRANTWAY ST
    DU QUOIN, IL
    ZIP 62832
  • Facility Phone: 618 542-2488
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: BETH A. MUDGETTE
  • NPI Number: 1164503272
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2140320
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0252
Street 215 E GRANTWAY ST
City DU QUOIN
State IL
ZIP 62832
Phone 618 542-2488
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 BETH A. MUDGETTE

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