14D2140352 CLIA NUMBER - WALMART PHARMACY 10-0852

Laboratory Demographics

  • CLIA Code: 14D2140352
  • Facility Name: WALMART PHARMACY 10-0852
  • Facility Address: 4041 VETERANS DR
    OTTAWA, IL
    ZIP 61350
  • Facility Phone: 815 434-0176
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: AMANDA I. BUSKING
  • NPI Number: 1467533570
  • Taxonomy: 332H00000X - Eyewear Supplier

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 14D2140352
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-0852
Street 4041 VETERANS DR
City OTTAWA
State IL
ZIP 61350
Phone 815 434-0176
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 I. BUSKING

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