14D2140358 CLIA NUMBER - WALMART PHARMACY 1490

Laboratory Demographics

  • CLIA Code: 14D2140358
  • Facility Name: WALMART PHARMACY 1490
  • Facility Address: 7219 WALTON ST
    ROCKFORD, IL
    ZIP 61108
  • Facility Phone: 815 399-7195
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: JEROLD A. MCKENZIE
  • NPI Number: 1013098151
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2140358
LAB Type Pharmacy
Facility Name WALMART PHARMACY 1490
Street 7219 WALTON ST
City ROCKFORD
State IL
ZIP 61108
Phone 815 399-7195
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 JEROLD A. MCKENZIE

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