14D2140327 CLIA NUMBER - WALMART PHARMACY 10-1307

Laboratory Demographics

  • CLIA Code: 14D2140327
  • Facility Name: WALMART PHARMACY 10-1307
  • Facility Address: 2080 NO ST ROUTE 50
    BOURBONNAIS, IL
    ZIP 60914
  • Facility Phone: 815 937-5145
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JORDAN YEOMAN
  • NPI Number: 1316116015
  • Taxonomy: 156FX1800X - Technician/Technologist

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CLIA Record

Field Name Field Value
CLIA Number 14D2140327
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1307
Street 2080 NO ST ROUTE 50
City BOURBONNAIS
State IL
ZIP 60914
Phone 815 937-5145
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 JORDAN YEOMAN

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