14D2140356 CLIA NUMBER - WALMART PHARMACY 10-1386

Laboratory Demographics

  • CLIA Code: 14D2140356
  • Facility Name: WALMART PHARMACY 10-1386
  • Facility Address: 1706 W REYNOLDS ST
    PONTIAC, IL
    ZIP 61764
  • Facility Phone: 815 842-2230
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: ANNE M. CASSON
  • NPI Number: 1922025295
  • Taxonomy: 3336C0003X - Pharmacy

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CLIA Record

Field Name Field Value
CLIA Number 14D2140356
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1386
Street 1706 W REYNOLDS ST
City PONTIAC
State IL
ZIP 61764
Phone 815 842-2230
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 ANNE M. CASSON

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