14D2140325 CLIA NUMBER - WALMART PHARMACY 10-0201

Laboratory Demographics

CLIA Number: 14D2140325

Facility Name: WALMART PHARMACY 10-0201

Facility Address:
2608 GREEN MOUNT COMMONS DR
BELLEVILLE, IL
ZIP 62221
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Facility Phone Number: 618 277-2020

Facility Type: Pharmacy

Certificate Type: Waiver

NPI Number: 1710904073

Taxonomy: 3336C0003X - Pharmacy
A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

CLIA Record

Field Name	Field Value
CLIA Number	14D2140325
LAB Type	Pharmacy
Facility Name	WALMART PHARMACY 10-0201
Street	2608 GREEN MOUNT COMMONS DR
City	BELLEVILLE
State	IL
ZIP	62221
Phone	618 277-2020
CertificateType	4
CertificateEffectiveDate	11/20/2023
CertificateExpirationDate	11/19/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024