14D2140359 CLIA NUMBER - WALMART PHARMACY 10-1418

Laboratory Demographics

  • CLIA Code: 14D2140359
  • Facility Name: WALMART PHARMACY 10-1418
  • Facility Address: 1530 WEST HWY 50
    O FALLON, IL
    ZIP 62269
  • Facility Phone: 618 632-9381
  • Facility Type: Pharmacy
  • Facility Type: Waiver
  • Lab Director: KEVIN L. TRACKWELL
  • NPI Number: 1881775906
  • Taxonomy: 332H00000X - Eyewear Supplier

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CLIA Record

Field Name Field Value
CLIA Number 14D2140359
LAB Type Pharmacy
Facility Name WALMART PHARMACY 10-1418
Street 1530 WEST HWY 50
City O FALLON
State IL
ZIP 62269
Phone 618 632-9381
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 KEVIN L. TRACKWELL

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